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SEA-Dis. Prep.-3 Distribution: General

Emergency Preparedness and Response: From Lessons to Action

Report of the Regional Consultation Bali, Indonesia, 27-29 June 2006

© World Health Organization

This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes.

The views expressed in documents by named authors are solely the responsibility of those authors.

January 2007

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Contents

Page

Executive summary................................................................................................ v

Opening of the Meeting ........................................................................................ 1

Objectives of the Meeting...................................................................................... 2

Methodology ......................................................................................................... 2

Summary of presentations...................................................................................... 3

1. Health in emergencies: A global perspective ................................................. 3

2. Review of the tsunami response .................................................................... 8

3. Lessons learnt from the tsunami: Community empowerment......................... 9

4. Lessons learnt: Sharing experiences on multisectoral coordination............... 12

5. Lessons learnt from the tsunami: Building country capacity ......................... 17

6. Evaluation of tsunami operations ................................................................. 20

7. Applications of lessons learnt from the tsunami – 1..................................... 24

8. Application of lessons learnt from the tsunami – 2 ...................................... 28

9. Group sessions – 1: Determining progress in benchmarks with regard to complex emergencies ........................................................... 29

10. Group session 2: applying benchmarks to pandemic preparedness.............. 44

11. Session on partnerships ............................................................................... 46

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Annexes

1. Bali declaration: A commitment to action, (29 June 2006).......................... 53

2. Welcome speech by Governor of Bali ......................................................... 55

3. Keynote address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia .................................................... 57

4. Inaugural address by Minister of Health of the Republic of Indonesia .......... 61

5. List of participants ....................................................................................... 63

6. Programme ................................................................................................. 66

7. Benchmarks ................................................................................................ 70

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Executive summary

Even for veteran emergency health experts, the tsunami was a unique experience, as one of the worst natural disasters in recent history, and one that affected six countries of the WHO South-East Asia Region simultaneously. The event marked a watershed in the history of disasters in the Region. It highlighted many critical issues, and enabled comparisons between different approaches to disaster management in different countries. After the response and early recovery phase, the current period has provided an appropriate time to reflect on the work done and strategies undertaken in the past, and learn how the lessons from this experience can be applied to future disasters all over the world.

The Regional Consultation on Emergency Prepared and Response: From Lessons to Action therefore focused on how to act on and incorporate the lessons learnt from the tsunami into disaster management policies and plans of every nation, so that they could be implemented to strengthen emergency preparedness and response at every level in every country in the Region. The emphasis was on action.

A global perspective of disasters revealed that disasters had increased in the past decade, highlighting the need to strengthen preparedness for such events. These crises have brought many important lessons to the fore and have highlighted, among others, the need for:

Ø national capacity building for risk management and vulnerability reduction,

Ø immediate availability of accurate information in order to take appropriate action,

Ø better coordination among different partners involved in disaster management through the cluster approach,

Ø local expertise trained to international standards.

WHO is adapting its role and preparing its future direction accordingly. The need for political commitment to disaster management has been stressed in the World Health Assembly resolutions WHA 58.1 and WHA 59.22 adopted by the Health Assembly 2005 and 2006 respectively.

Report of the Regional Consultation

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The response to the tsunami by the health sector was reviewed. It was seen that the lessons learnt from the tsunami – the need for preparedness, for better coordination among health agencies, etc. – were successfully applied to the response to the Yogyakarta earthquake.

Among the key lessons learnt from the tsunami were the need for community empowerment to deal with disasters, for multi-sectoral coordination, and national capacity building. Community empowerment involves providing the community with timely, correct information, relevant training and resources, and identifying a leader within the community. The experience of the Thai Red Cross in working with the tsunami-affected communities emphasized the need for the community to be trained to respond appropriately and immediately when disasters occur, without relying on external assistance which may take time to arrive. To achieve this, the people need to be aware of the risks of potential disasters in their geographical area, to organize warning systems, have a community-based leader and trained volunteers, to identify in advance evacuation points and the closest hospital/health centre/place of assistance. Exercises and drills for emergencies, both real-time and scenario-based, are crucial for effective community preparedness.

The importance of multi-sectoral coordination during disasters has emerged as a fundamental issue following the tsunami. No single agency or sector can effectively respond to a disaster, and competition among agencies is detrimental to the agencies and, more importantly, to the affected people and benefits nobody. While in many countries such as India, the vertical chain of command during emergencies has been established, and coordination mechanisms within the government, at the central, state and district and local levels have been put in place, ways to consolidate ‘horizontal coordination’ among partners is less clear. The health cluster approach, where all health sector agencies work together with WHO leading on behalf of the Ministry of Health, could be one approach. This was successfully implemented in Indonesia following the Yogyakarta earthquake of May 2006.

The role of nongovernmental agencies (NGOs) has been discussed. While NGOs that possess the required skills and logistical capabilities can play a very important role in a disaster-affected community, NGOs without the necessary skills could cause difficulties. There is also the question of accountability. In discussions, the general consensus was that the role of NGOs should be coordinated by the government at the local level. Political


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commitment was also seen as crucial for effective multisectoral coordination, and this has led to disaster management agencies to be headed by the Prime Minister or President in countries such as India, Myanmar, and Sri Lanka.

Even with the highest level of political commitment, no country can be prepared for a disaster without national capacity to deal with disasters. Capacity building, and training of human resources, is therefore integral to disaster management. Experiences from recent disasters have revealed that while technical knowledge is necessary, successful management of disasters requires efficient and capable managers and operators. Accordingly, the Asian Disaster Preparedness Centre (ADPC), has now adapted its training courses to emphasize wider skills to build more effective ‘managers’ rather than building technical skills.

The first step in capacity building is capacity assessment, and benchmarks are needed to assess what one needs to achieve and how far one has to go in every country. Member States of the South-East Asia Region had developed 12 benchmarks for emergency preparedness and response in a meeting in Bangkok in November 2005. At the Bali consultation, participants analyzed the progress in the benchmarks in relation to community empowerment, multisectoral coordination, capacity building and standards and guidelines. They looked at specific achievements, as well as barriers to achieving those benchmarks. In some cases, benchmarks were modified, for example, the benchmark on advocacy and awareness was changed to include media relations and now reads as follows:

‘Advocacy and awareness developed through education, information management and communication, including effective media relations (pre-, during and post-event)’

For all activities, financial resources are needed. A Regional Emergency Fund has been suggested. More flexibility in funding mechanisms was emphasized.

At the consultation, the Bali Declaration was adopted, urging Member States to improve multi-hazard disaster preparedness, and convert the Bangkok meeting benchmarks into a strategic action framework by developing measurable indicators with timelines. For full text of the Declaration, please see Annex 1.

Opening of the Meeting

The opening session of the meeting was attended by: Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region; Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region; Dr. Nyoman Kandun, Director-General, Communicable Disease Control and Environmental Health, Ministry of Health, Government of Indonesia, who represented the Minister of Health. Also present were the Head of the Bali Provincial Health Office, Dr Dewa Ketut Oka, representing the Governor of Bali, and Dr Georg Petersen, WHO Representative to Indonesia.

In his welcome address, Dr Oka’s emphasized that Bali was no stranger to disaster, having suffered two bomb blasts in 2002 and 2005, which caused hundreds of deaths. Due to lessons learnt from the 2002 disaster, the response following the 2005 blasts was more effective, with victims being rapidly transferred to hospitals. The outcomes of this meeting, and lessons learnt from other disasters, would also benefit Bali. For full text of the address, see Annex 2.

Delivering the keynote address, Dr Samlee said that this is an opportunity to learn from the lessons of the past to be able to cope better in future. He cited the example of the Yogyakarta earthquake, where two features were significant: firstly, preparedness was better than in past disasters. Preparedness for a potential eruption of the Mount Merapi volcano, approximately 20 kilometers from Yogyakarta, resulted in important resources being placed there. These could be easily mobilized following the earthquake. Secondly, having learnt lessons from the tsunami, work in the health sector was done in a more coordinated manner. It was worth mentioning, he said, that guidelines developed during the tsunami helped in the emergency following the Yogyakarta earthquake. The full text of Dr Samlee’s address is in Annex 3.

Representing the Minister of Health, Dr Kandun delivered the inaugural address. He said that since the theme was ‘lessons to action’ and


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involved reviewing recent disasters and crises, he believed this meeting would be useful and effective for all countries, particularly Indonesia, which, for many centuries, has suffered earthquakes, volcano eruptions, floods, landslides as well as drought and consequent famine. Large scale epidemics and new emerging diseases such as Avian Influenza could also be serious threats to the country. He thanked WHO for its assistance before, during and after emergencies. The text of the inaugural address is in Annex 4.

Objectives of the Meeting

The objectives of the meeting were:

Ø To review the work done post-tsunami and the lessons learnt from the experience.

Ø To review the progress in countries in achieving the regional benchmarks for emergency preparedness and response (EPR), as defined in the Bangkok meeting (November 2005) .

Ø To identify strategic actions for the rehabilitation and development of the tsunami-affected areas and for those impacted by the more recent emergencies.

Ø To consolidate action points into a framework for intensifying country/community capacities for emergency preparedness and response.

Ø To create a cohesive plan by integrating the output from other meetings since November 2005.

Methodology

Presentations were made on key issues related to lessons learnt from the tsunami and their relevance to disaster preparedness in health, by experts from WHO, government representatives, or leading NGOs. These presentations were followed by discussions on the respective topics.

The participants were then divided into four groups. The groups discussed the progress so far, and the way forward to achieving the


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Bangkok benchmarks for emergency preparedness and response in the Region. Each group discussed the benchmarks in relation to one of the following:

Ø Multisectoral coordination

Ø Community empowerment

Ø Capacity building

Ø Standards and guidelines

Based on the discussions, the participants formulated and adopted the Bali Declaration.

Summary of presentations

1. Health in emergencies: A global perspective

Across the world, crises are triggered due to a number of reasons:

Ø Sudden, catastrophic events – like earthquakes, hurricanes, flooding, or industrial incidents.

Ø Complex, continuing emergencies – including the large number of conflicts underway at this time, and the many millions of people displaced as a result.

Ø Slow onset disasters – such as the increasing prevalence of fatal HIV infection, or economic collapse.

In the past decade there has been an increase in the global magnitude of crises, highlighting the need to be better prepared for such events. This has implications for the role of WHO and its partners.


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Time trend of natura l dis a s ters* 1975 - 2005

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2005 disasters in numbersSource: CRED

Source: CRED 2005 disasters in numbers

The recent crises around the world have brought to the fore various important lessons. These include:

Ø Preparedness : Preparedness and national capacity building for risk management and vulnerability reduction is essential


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Ø Information: Immediate availability of accurate information is essential for assessing, monitoring and taking appropriate health actions in emergencies.

Ø Cluster Approach: This has been a positive experience but future implementation requires additional efforts in management, planning, and institutional capacity building. Clarity on roles and responsibilities of various agencies is required. Coordination with governments and health partners should be improved.

Ø Response: Gaps in the response need to be addressed in various areas e.g. mass casualty management, water and sanitation, nutrition, non-communicable diseases, maternal and newborn health, mental health etc.

Ø Private Sector Involvement: The private sector and military are frequently involved in disaster response. There is therefore a need to agree on procedures/criteria for collaboration and joint efforts.

Ø Heath, Nutrition & WATSAN/hygiene: Gaps have been identified in joint work in nutritional assessments and medical aspects of management of nutrition. Coordination has to be strengthened between the health, water and sanitation and nutrition sectors/clusters.

Ø Vulnerable groups: The vulnerability of women and children and the risks their health faces in crises need to be addressed. To achieve this, one element needed is data disaggregated by sex. The impact of response on women and female field workers needs to be assessed and adequate supplies in reproductive health and emergency obstetrics provided.

Ø Local Expertise: Local experts trained to international standards will form a valuable resource for their region, providing long-term support.

Ø Human Resources: Quick identification and mobilization of appropriately equipped and trained personnel is essential. There should therefore be a roster of experts on call.

WHO has recognized the need to incorporate these lessons as the basis for future directions in emergency preparedness and response. This recognition was translated into political commitment through the World


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Health Assembly 2005, resolution WHA 58.1 in 2005. The resolution committed to:

Ø Enhance capacity to support countries in developing and implementing health-related emergency preparedness plans

Ø Enhance capacity to respond to the critical health needs during crises

Ø Mobilize WHO health expertise for response operations

Ø Enhance capacity to assist countries in planning and implementing transition and recovery programmes

Ø Intensified WHO support for Member States affected by crises and disasters through:

Needs assessments Health coordination Filling gaps and restoring public health functions Capacity building

The World Health Assembly resolution WHA 59.22 in 2006 further committed to disaster preparedness, through:

Ø Support to national health emergency preparedness and response programmes with emphasis on community preparedness and resilience

Ø Assessment of resilience and risk management capability of hospitals

Ø Maintaining joint work with other UN agencies and partners

Ø Taking part in UN system-wide mechanisms for logistics supply and management

Ø Establishing a mortality tracking service

Ø Compiling a global database of technical health references

WHO has four core functions in emergencies:

Health assessment and tracking: Ensuring proper assessments are undertaken, assessing needs and priorities, surveillance and monitoring of the impact of humanitarian responses.


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Coordinated health action: Convening different actors, exchanging information, agreeing on strategies in response to assessments, joint and focused action.

Filling gaps: Identifying gaps in the response that have a significant impact on survival rates and levels of ill-health and restoring public health functions.

Strengthening local capacity for health outcomes: Training, rehabilitating essential structures, repairing and restarting broken systems, empowering critical professionals.

There are three areas for strengthened action for WHO and Member States:

(1) Emergency preparedness and capacity building

(2) Emergency response and operations

(3) Recovery and transitions

Current WHO initiatives in this regard include:

Ø WHO Strategy on the promotion of country emergency preparedness and response capacities

Ø Global survey on the status of emergency preparedness at country and community levels

Ø Guidelines and best practice in mass casualty management

Ø Implementation of the cluster approach; global health cluster lead; roll out of the health cluster in selected countries

Ø Emergency SOPs and operational platforms

Ø Guidance and standards on chronic disease management in emergencies

Ø Training courses and development of the roster of rapidly-deployed well-trained personnel

Ø Health, nutrition and mortality tracking service (partnership between the Health and Nutrition Clusters)

Ø Global consultation on health aspects in transition and recovery situations


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2. Review of the tsunami response

This session looked at how lessons from the tsunami have been taken forward, and how to address the gaps.

Following the tsunami, the need to invest in national capacity for risk management, preparedness and vulnerability reduction has been clearly recognized. Improved needs assessment tools also need to be developed, adapted and made available. To achieve high levels of preparedness, benchmarks and standards need to be developed in various areas. In this regard, WHO had recently developed benchmarks for emergency preparedness and response for the Region.

The post-tsunami response particularly highlighted the need for coordination. This included:

Ø the need for pre-arrangements, pre-agreements, clear mechanisms and leadership in the context of decentralized governance

Ø rules of engagement with humanitarian actors (also a benchmark)

Progress on this has been variable in countries where legislation and administrative changes have taken place.

The lessons learnt from the tsunami have been reflected in the response to the earthquake in Yogyakarta. Consequently, in Yogyakarta, the response was

Ø government-led and well coordinated

Ø public health needs were addressed according to the local context and resources

guidelines from the tsunami adapted for Indonesia were quickly mobilized and used (e.g., communicable disease surveillance, environmental health)

Ø public health gaps were addressed through proper assessments in coordination with other sectors

Ø the affected community was involved as a partner- e.g., students trained by the academies assisted in psychosocial efforts.


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However, we need tools to identify gaps so that the situation is constantly monitored and precisely described. This is the key, as in all phases in disasters and for various players we should be able to match the gap, need and strategic action. Systems to monitor progress of efforts should not only be quantitative but qualitative as well- this was partly addressed by the Tsunami Recovery Impact Assessment and Monitoring Systems (TRIAMS).

Another challenge is penetrating to the community level. Much of our work should penetrate the lower levels of administration, and, at the same time, encourage action from the communities themselves which will be integrated into the larger picture of EPR. The linkages of governments and communities; the platforms provided for these to happen are key in making this happen.

The third challenge is applying lessons and extending them to different contexts. Much of the mechanisms needed for proper preparedness and response are the same. However, due to certain issues whether technical, socio-political or economic, these are not addressed.

Although good progress has been made, much more needs to be done to ensure that the lessons learnt from the tsunami are incorporated and implemented in disaster preparedness and response in the Region.

3. Lessons learnt from the tsunami: Community empowerment

The technical sessions on Lessons Learnt: Sharing Experiences on (a) Community Empowerment, (b) Multi-sectoral Coordination and (c) Strengthening Country Capacity for Preparedness and Response were chaired by Dr Poonam Khetrapal Singh.

Lessons learnt from Thailand

The Thai Red Cross has been working closely with the tsunami-affected people ever since the tsunami struck. Initially, it had sent a small medical unit to assess the situation. Then, a small team was put together and a plane load of necessary supplies sent for the affected people. It is now setting up a community-based disaster risk reduction (CBDRR) programme in tsunami-affected areas.


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Its success in responding to the tsunami has been attributed to many reasons: royal patronage, its ability to mobilize volunteers across district and other boundaries; strong leadership and focus, prompt action, as well as the inherent compassion of the Thai people, and the willingness of all agencies to work together.

However, there were many weaknesses that made the impact of the tsunami worse. People were unprepared because nobody knew much about tsunamis. People did not take warnings seriously. Traditional wisdom and knowledge – old tales about tsunamis – had been forgotten. Had they been remembered and taken seriously, people would have recognized the threat and reacted accordingly, and fewer lives would have been lost. Destroying nature and natural protection by building hotels and resorts next to the shore line also exacerbated the impact of the tsunami.

In the experience of the Thai Red Cross, the core components of community preparedness are:

Ø Everyone should recognize the different types of disaster and their effect to themselves, their families and property.

Ø Everyone should be familiar with the warning system

Ø A leader should be identified and recognized within the community

Ø All should know the geographical area and potential risk in that area

Ø People should learn how to prepare food in an emergency and also where to get the food

Ø When a disaster occurs, people should know where to go

Ø When a disaster occurs, pre-identified volunteers should be available to provide help

Ø Communication network system

Ø Transportation

Ø Important documents should be safeguarded in advance

Ø First aid and Medical treatment for injuries

Ø Supplies and necessities

Ø Coordination between concerned organizations


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Ø Security system, including prevention of robbery

Ø A clearly designated meeting point for agencies involved in relief operations

Ø Channel of disaster information

Ø Monitoring of disaster impact

Ø Planning together, developing a work plan

Ø Drills conducted in real time based on scenario communication may face

Ø Identifying the nearest health station / hospital / mobile medical teams/ place for assistance

In conclusion, to be effective, community capacity strengthening and ownership is needed in following areas:

(1) Knowledge and understanding of risks, hazards and response systems that should be in place

(2) Disaster risk assessment

(3) Disaster response plan and exercise

(4) Disaster announcement and communication including news update

(5) Disaster response system including supplies, materials and equipment

(6) Disaster management structure in the community and in the province

To achieve this, the following steps need to be taken:

(1) Volunteers should be trained from the community in the skills needed for each phase in the cycle, including search and first aid

(2) Community fund for disaster

(3) Establishment of a network of communities for collaboration

(4) Arrangement of collaboration and assistance from public and private partners including government agencies and NGOs

Comments and Discussions: Questions were raised on how to recognize leaders in the community. It was commented that although the


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government has various authorities, for cohesive community participation, leaders should be from within the community. The important role played by religious leaders in relief efforts following the tsunami was highlighted.

The role of WHO was also discussed briefly. It was suggested that WHO should help in mapping out roles and responsibilities of health partners and NGOs in advance.

Dr Samlee commented that the issue of inter-agency coordination has been discussed often but not much has been done. The key issue now is action, not talk. The tsunami of 2004 has taught an important lesson – that international agencies cannot work in isolation.

Dr Poonam Khetrapal Singh cited collaboration between UNICEF and WHO in the area of water and sanitation during the tsunami of 2004 as a good example of international agencies collaborating for the benefit of the people.

The session concluded with a reminder of the ‘triple A’ needed for effective community preparedness: awareness, action and advocacy.

4. Lessons learnt: Sharing experiences on multisectoral coordination

The Indian experience

The presentation on the subject provided an overview of how the large number of disasters in the past decade led India to form a National Disaster Management Authority (NDMA) and pass the Disaster Management Act 2005 on December 26 2005, exactly one year after the tsunami.

The economic, social and political consequences of several major disasters in India in the past decade had made it clear that a more comprehensive approach to disaster management was needed. Before the tsunami, among the lessons learnt from the Gujarat earthquake of 2002, it was realized that there was:

Ø No national level policy/plan/ legislative framework

Ø No dedicated disaster management framework at the Central/ State/ District levels


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Ø Inadequate sectoral coordination for prevention, preparedness, mitigation and response

Ø Low level of organized participation by community / nongovern-mental organizations and

Ø The district magistrate’s role was mainly relief-centric.

The Orissa cyclone of 1999, and the Gujarat earthquake of 2002 highlighted the need for a change in orientation in disaster management from relief-based to a more holistic, multi-dimensional approach. The tsunami of 2004 accelerated this process. The new approach, it was felt, should encompass prevention, mitigation, preparedness, response, relief and rehabilitation for sustainable development. A well-defined chain of command and coordination mechanisms between agencies should also be put in place.

A National Disaster Management roadmap was therefore drawn up, and recommended the following:

Ø legal/policy framework

Ø institutional mechanisms

Ø prevention, preparedness & mitigation Ø early warning systems

Ø robust response

Ø human resource development

Ø capacity building

Based on the roadmap, the Disaster Management Act 2005 was passed by Parliament. It includes several key features that lays the framework for the disaster management structure and function in India, at the national, state and district levels:

Ø establishment of NDMA, SDMA, DDMA at National, State and District levels respectively and lays down roles and responsibilities, powers & functions of each institution

Ø Measures to be taken by the Central and State Govts., and local authorities

Ø National executive committee consisting of secretaries of 14 major disaster related departments


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Ø National Disaster Response Force

Ø National Disaster Response & Mitigation Funds at three levels

Ø National Institute of Disaster Management

Highlighting the importance of disaster management in the country, the NDMA has the Prime Minister as the chairperson. The structure is given in the following diagram. Similar structures have been set up at the state and district levels. The role of NDMA is as follows:

Ø Lays down policies on disaster management and approve the National Plan

Ø Lays down guidelines for different departments for the purpose of integrating the measures for prevention/ mitigation

Ø Coordinates the enforcement/ implementation of the policy and plan for DM

Ø Provides support to other countries affected by major disasters

Ø Recommends guidelines for minimum standards for relief

Ø Similarly, SDMA & DDMA would coordinate and implement the National Plan, State Plan & District Plan

National Disaster Management Authority

Prime Minister – Chairperson

Vice Chairperson

8 Members

National Executive Committee

of Secretaries

Advisory Committee of

Experts


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When a disaster strikes, the immediate response is at the district and state level, with the district magistrate’s office playing a key role. However, the central government has a crucial, coordinating function. Its role includes:

Ø Coordinating the actions of ministries/ departments of Central/ State Govt. statutory bodies and NGOs

Ø Ensuring integration of measures for prevention, preparedness and mitigation

Ø Coordinating with the armed forces

Ø Coordinating with UN agencies and other international agencies

To ensure coordination for effective preparedness:

Ø An annual review of preparedness at the national level takes place in the meeting of State Relief Commissioners/ Secretary (DM)

Ø Similar review meetings take place at the state and district levels prior to the national meeting

Ø Inter-ministerial meetings review the status and serve as an interface between line ministries and States

Ø Issues flagged in these meetings are fast-tracked for action

However, although India has taken many steps recently in the area of disaster management, some important challenges remain. These include:

Ø Need to strengthen vertical chain of command and horizontal coordination at State/ District level

Ø The role of NGOs needs to be defined clearly at all levels

Ø Coordination between civil administration and defence forces at operational level (district level mainly) needs to be strengthened

Ø Integration of incident command system with existing disaster management framework

Ø Resource mapping for India Disaster Resource Network


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Comments and Discussion

Ø High-level political commitment: this was seen as the most important factor in multisectoral coordination for effective disaster preparedness. In Myanmar too, for example, the National Disaster Authority is chaired by the Prime Minister, with relevant ministers involved. Each minister coordinates with UN agencies, iNGOs and local NGOs, in line with the cluster approach1 of the UN. In Sri Lanka, too, the National Council of Disaster Management is headed by the President.

Ø Coordination: The question of coordination between the government and NGOs was brought up by Bangladesh as a problem. In India, the office of district collector is seen as playing a pivotal role and is the focal point for civil society, including NGOs, in a disaster. NGOs can play a very important role in disasters. However, they need to have the relevant expertise and experience to match the needs of the moment, and unless they work in a coordinated manner they could add to the burden. Dr Poonam Khetrapal Singh shared that after the tsunami, for example, India allocated one village to one NGO in the relief and recovery phase and this seemed to work well.

Ø The role of international agencies: It was felt that the national authorities should tell UN agencies what role they should play. It is important that UN agencies add to, rather than substitute, government efforts.

Ø Information management: The importance of information flow and management in disasters was emphasized. This is crucial as only with accurate information about the situation and needs following a disaster can the response be effective. It was suggested that the government should provide information to NGOs, and the NGOs working in the field can also provide valuable information to the government.

Ø Role of the military: Another important player in disasters is the military. The consensus was that the military played an important

1 The cluster approach is the current framework of response being implemented by the UN.


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role in disasters as few civil organizations can match their logistical resources from troops, for search and rescue, to helicopters and other equipment. In India, for example, the Chief of the Integrated Defence Staff is also on the committee of the National Disaster Management Authority.

Ø Accountability: Accountability of all was emphasized, not just financial accountability, but accountability to the people.

5. Lessons learnt from the tsunami: Building country capacity

Strengthening Country Capacities: A systematic approach

The presentation focused on Asian Disaster Preparedness Center’s (ADPC) strategies and experiences in building capacity for disaster preparedness in countries of the Asia-Pacific. It began with a definition of national capacity to manage health risks during disasters:

“the sum of capability, resources and relationships aimed at reducing illness, disability and death from these risks and at promoting health, safety and security”

This was the definition used in the report “National capacity to manage health risk of deliberate use of biological, chemical and radiological agents: Guidance on capacity assessment” (WHO, final draft 2006).

Building capacity, therefore, involves building:

(1) systems operating at each administrative level; systems in specific sectors; systems to manage specific types of risks; systems for specific functions or services.

(2) organizations that contribute to these systems by providing coordination and the capacity to perform functions

(3) people- investing in those who work in this sector for a career or as volunteers and those people in the community, as well as managers, coordinators, and operators.

The first step in capacity building is capacity assessment, which can be done with the help of the 12 benchmarks developed by WHO/SEARO. Then follows capacity development, which should be oriented towards


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critical issues of institutional sustainability. There should be cross-sector, multidisciplinary partnerships.

Training is key to successful capacity building for disasters. At ADPC, using case studies and demonstration projects, real lessons from past disasters are converted to simulation exercise scenarios so that they get incorporated into training. There should be simultaneous implementation of bottom-up and top-down strategies.

While technical knowledge is necessary, recent disasters have shown that successful management of disasters requires efficient, capable managers and operators. Accordingly, in the new Public Health and Emergency Management in Asia and the Pacific (PHEMAP) courses designed by ADPC, the training emphasis has changed from technical areas to wider skills to build more effective ‘managers’.

To summarize, the following steps are recommended for national capacity building:

Ø Develop the health emergency risk management framework

Ø Conduct capacity assessment at national, sub-national and regional levels

Ø Work towards institutionalizing health emergency management system Establish and sustain health emergency management units Build partnerships – intrasectoral and intersectoral Adopt multi-disciplinary activities Strengthen and support the capabilities of health emergency

managers Ø Develop and disseminate case studies and demonstration

projects

Ø Advocate for people’s health in disasters

Comments/Discussions

Ø Access to information and tools for disaster management: There were questions about how NGOs could access and learn from those tools on disaster management. The SEARO website was identified as a good source of information.


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Ø Research on disaster health: It was also pointed out that disaster health as a science has been neglected. As a consequence, in India, for example, thousands of lives were lost due to leptospirosis in Mumbai, and there is a current outbreak of Chikungunya of which little is known. It was felt that while there was plenty of research on disaster management in general, health emergency management had not received due attention. PAHO’s training material, particularly the publication, ‘Myths and Realities in Disasters’ was seen as a good resource.

Ø Standards and benchmarks: The importance of standards and benchmarks, and a systematic approach to health emergency preparedness for capacity building, was emphasized. So was the importance of information and communication at various levels.

Ø Other key issues discussed included the following points:

Need for institutionalization of health emergency management

Capacity building is best directed at the local level, but there must be systems in place

Plans for systematic capacity building must be in place at all levels

Standards are needed for effective capacity building.

Conclusions: key lessons learnt

Experiences from disasters create windows of opportunity to learn and improve. For example, in India, lessons learnt from the Gujarat earthquake set into motion systems for disaster preparedness which were accelerated by the tsunami. The tsunami also created international awareness and the need for political commitment which led to the adoption of World Health assembly resolutions on emergency preparedness and response in 2005 and 2006. Medical care is only a small part of the broader spectrum of public health issues in emergencies.

A combination of skills are needed for effective disaster preparedness and response, and no single agency can act in isolation. Multisectoral coordination is therefore crucial for effective response. The government of the country is best suited to lead the coordination, with agencies supporting the government in this role, such as the health cluster formed following the


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Yogyakarta earthquake which was led by WHO on behalf of the Indonesian Ministry of Health. However, challenges remain. While vertical coordination – the command and control system within a country – can be resolved through a good national disaster plan and political commitment at all levels, the way forward in ‘horizontal’ coordination among partners, and the role of each partner is more difficult. Coordination involves all partners, including the private sector and the military, and their roles in a disaster also need to be clarified in any plan.

In any disaster, it is the community that responds in the first few hours, before external assistance arrives. Therefore, building community awareness and empowerment is very important. This includes leadership at the community level, knowledge of what to expect, how to respond, where to go, etc.. Education and training at the community level is the key. In countries like Myanmar, including disaster management related issues in school curricula has helped increase awareness.

Training, and therefore capacity building, is in fact needed at all levels. Standards are required for this, and SEARO’s 12 benchmarks are a significant step forward.

At all levels, information management and dissemination and communication plays a vital role.

6. Evaluation of tsunami operations

In evaluating SEARO’s response to the tsunami, several points can be highlighted. The speed of response was notable as experts were mobilized within hours of the tsunami. The speed at which a response is mobilized can reduce the direct as well as indirect impact. The personal commitment of those involved also impacts response effectiveness and was notable during tsunami operations. Communities are, nonetheless, the first responders and the most effective tool available in early response.

WHO is characterized by a unique privilege and responsibility in its relationship with the Ministries of Health of Member States. The relationship has worked particularly well in some post-tsunami environments, notably in Sri Lanka. WHO’s technical capacity is a unique feature, not available elsewhere. There is a large body of experience within


Page 21

the Organization that can be utilized by countries to build their capacities from to move forward.

Within WHO there was delegation of authority to country offices post-tsunami that allowed for the flexibility needed in disaster response. However, such delegation calls for increased training as needed and expanded terms of reference. The tsunami forced a degree of financial flexibility within the Organization that did not previously exist but was necessary for prompt and appropriate response. As surveillance data was collected within a week of the tsunami, the visibility of the impact of early response was recorded.

Several questions were, however, raised in the evaluation of the tsunami response:

Ø Inclusiveness – not all technical programmes were represented

Ø Prioritization – not all priorities of disaster response were met

Ø Evidence-based decision making was not always implemented

Ø Coordination – technical resources were under-utilized as a result of competition

Ø Monitoring – situations change more rapidly on the ground than organizations have the ability to keep pace with

Ø Human resources – utilization of available resources was not a strong point and duplication was common. The community should be used first, then country experts

Ø Procurement – a specialized procurement system should be explored to support the needs of the organization

Ø Resource mobilization – a new approach is called for as well as a contingency plan

Funding for tsunami operations lacked absorbability. Programmes were limited by the conditions of the flash appeal that lacked flexibility. The role of the donors was additionally redefined as greater flexibility in spending was needed as activities changed.

The proliferation of NGOs in the past decade is also an area that must be addressed as not all NGOs are equally competent or accountable.


Page 22

Governments must be selective in accepting aid from NGOs and should ensure that projects launched meet the needs of the population.

The logistical strengths of the military were also very apparent in the tsunami response. Greater coordination is called for with the military in order to best determine the most effective means of collaboration.

Religious institutions can be employed in areas particularly in need of cultural sensitivity such as mental health. Proselytizing aside, religious institutions are most often the places that affected populations seek for comfort and support.

The media is one of the most important driving forces during an emergency. They are often the first to report on disaster situations and are usually on the ground shortly after an emergency.

Coordination was a weakness during the tsunami. There is still much to learn and will be the key to future successes. An awareness of the reconstruction phase is also a key point for both organizations and donors. Disasters move to a development phase through the transitional reconstruction phase.

The themes highlighted during the Tsunami Evaluation Coalition included:

Ø Variable quality needs assessments had a low impact

Ø Policy makers must use tools more effectively

Ø There was poor coordination and high competition

Ø Local capacity was impacted inconsistently

Ø The environment was constrained

Ø Funding was inflexible

Growing climatic, social and health changes demand a new system that respond better to the new environment. There are changing health and health system needs and WHO is in a unique position to fill the gaps. The number of disasters, both natural and man-made, are increasing worldwide and reform is necessary both in functions and programmes to enable the Organization to keep pace.


Page 23

Actions to be taken based on the lessons of the evaluation include:

Ø Country adaptive programmes developed in parallel to region-wide preparedness

Ø Region-wide response capacity, resource mobilization, monitoring and evaluation, multisectoral coordination, human resource, commodity pipelines and communication strategy

Ø Rationalization of efforts such as the development of SOPs and guidelines and surveillance databases that are comprehensive rather than limited to communicable diseases

Ø Inter-regional leadership by SEARO and Member States

WHO and Member States must be more proactive and operationally ready in responding to and preparing for disasters. WHO must be operational and technical. Work must be evidence-based and autopsy-oriented in order to ensure that causes and effects are understood. The Organization must be technically ahead in order to best facilitate knowledge sharing and support research, advocacy, training and overall strengthening of the health sector in response to disasters.


Ø Role of the private sector: The role of the private sector in coordination efforts was generally supported. WHO has a history of recruiting primarily public sector experts, but the private sector should be explored for possible collaboration as seen with Pfizer in the water and sanitation response.

Ø Regional funds and planning: Regional planning is crucial in that the impact of disasters is often felt outside national boundaries. Emergency funds should be set aside by each Member country as it is often difficult to mobilize sufficient funds on time to provide needed support. A Regional Solidarity Fund could be explored in order to reduce dependence on outside sources.

Ø Inter-agency collaboration: Inter-agency collaboration was successful as seen in the work conducted in water and sanitation with UNICEF following the tsunami. WHO filled an advisory position while UNICEF provided operational strength. The water


Page 24

and sanitation team also used a wide range of information from previous disaster response programmes.

Ø Delegation of authority: It was noted that in Sri Lanka the delegation of authority was often an issue as there was little preparation for the prioritization of needs and responsibilities. The proliferation of NGOs was an issue in Sri Lanka. Suggestions included collaboration between external NGOs and local NGOs to avoid overlap and duplication.

Ø Media relations: WHO did not have media officers at the country level at the time of the tsunami. Although media officers were mobilized shortly after, media relations has a significant impact on donors and policy makers and should be seen as a priority. Quality information should be made available to ensure the public is properly informed and the effect of incorrect information is offset. The ability of the health sector in general to handle media inquiries should be strengthened.

Ø Role of NGOs: It is the responsibility of the government to ensure that the role of NGOs is made clear and the quality of output is managed. NGOs are beginning to look at this issue themselves and the UN role could be useful in providing technical guidance and support. Disaster response should be cognizant of long-term needs and transition time. NGOs should not replace government efforts. Ministries must be strengthened as NGOs can come and go but continuity must be maintained.

Ø Reproductive health needs: Reproductive health issues could have been better addressed and integrated in the immediate response in order to meet more effectively minimum standards in disaster and recovery efforts. Reproductive health should be addressed comprehensively with less focus on family planning.

7. Applications of lessons learnt from the tsunami – 1

Review of response to the Java earthquake

Indonesia is prone to disasters, both natural and man-made, throughout the archipelago. An evaluation of the geographical distribution of disasters in


Page 25

the country shows that every island has experienced numerous types of events from volcanoes, earthquakes and floods to conflict, terrorism and environmental pollution. Out of 13 disasters that have occurred in 2006, nine were floods and flash floods, often with resultant landslides. The remaining events included transportation and industrial accidents, the eruption of Mt. Merapi and the recent devastating earthquake in Yogyakarta.

Between 2004 and 2006, Indonesia suffered nine earthquakes in eight provinces, spanning form the most western province to the most eastern. The earthquake that occurred in Yogyakarta and Central Java Province on May 26, 2006 resulted in 5 700 deaths, 151 225 injuries and 2 111 892 displaced people. There was extensive damage to health sector facilities – 104 health centres, 231 sub health centres, 4 hospitals and 173 staff housing facilities. Tetanus infections were a cause for concern – 73 people were treated, of whom 25 died.

During the first day following the earthquake, hospitals recorded 4 115 operations which rose to 14 220 the following day. Three mobile units were provided for the evacuation of victims and another 30 provided health services in remote areas. Food supplements were additionally distributed in Phase I for infants, children under 5 and pregnant women. During the second week following the earthquake, immunization and surveillance issues were addressed. Mobile clinic services during Phase II were increased by adding 20 surveillance teams and 10 specialist units. Phase III, the current phase as of 28 June, will focus on restoring health services, mental health and rehabilitation.

The nature of the disaster in Yogyakarta and Central Java was different from the tsunami in that the ratio of injuries to deaths was 25:1, the opposite of the ratio in Aceh. The affected area in Aceh was much more expansive and damage to facilities often resulted in complete collapse, where as in Yogyakarta and Central Java, buildings often remained standing. The provision of disaster relief in Aceh was additionally complicated by the ongoing civil conflict and inaccessibility.

Despite the differences between the two events, Government officials were able to apply the lessons of the tsunami to the earthquake and enhance planning for preparation and management of emergencies. The applications of lessons learnt include:


Page 26

Ø Preparedness and contingency planning included the preparation of health facilities, MoH planning and training, the replacement of the Crisis Centre directly under the Minister of Health and coordination with the Secretary-General

Ø Logistics set–up and Supply Management including transport and communication, human resources and supplies

Ø Rapid assessment Ø Coordination with other sectors through the cluster mechanism

and internal coordination between MoH, provincial and district health officers and hospital networks

Specific health sector responses that emerged from the lessons of Aceh included:

Ø A re-adapted communicable disease surveillance system Ø Quick distribution of mental health guidelines Ø Hospital needs addressed promptly Ø Mobilization of specialists from other districts Ø Immunization Ø Tetanus infection control

The leadership of the government was a key characteristic of the earthquake response in Yogyakarta. Preparedness was heightened prior to the earthquake as the Mt. Merapi volcano, 30 kilometers from Yogyakarta, showed increased activity. Local experts and institutions were tapped in mobilizing resources, health staff, funds and supplies from nearby provinces and districts. The command post approach which utilizes operational units was also employed.

The areas that need improvement include:

Ø Earthquake-proof health facilities and staff housing that can withstand earthquake

Ø Screening of health professionals, supplies and donor support Ø Multiple entry supply sites for supply management Ø Health staff trained in mass casualty management Ø Information management system Ø Specific SOPs Ø Quality of care for the injured


Page 27

The national organizational structure for disaster management in Indonesia emanates from the National Disaster Coordination Board (Bakornas PBP) chaired by the Vice President. At the provincial level, the Governor chairs the Province Disaster Coordination Board (Satkorlak PBP) which further interacts with the District Disaster Coordination Boards (Satlak PBP) chaired by district heads. Districts are responsible for the organization of a Health Task Force among other task forces including social, public works and security.

Health sector coordination in Yogyakarta was supported by WHO in the formation of the Health Cluster which addresses general issues including surveillance, immunization, mental health, child health, reproductive health, nutrition, health services, health information and supplies.

Improving area-based response efforts can be accomplished through:

Ø Monitoring and analyzing the tendency of health crisis and potential disaster

Ø Mobilizing local resources

Ø Increasing cross-sectoral cooperation Ø Evaluating response efforts to improve the system

Ø Improving the capability and capacity of available resources

Ø Institutionalizing response activities based on local potential

Recommendations for improving the disaster response mechanism in the future included:

Ø Coordination with all parties under authorization of Bakornas Ø Efforts by all parties in handling emergency health problems

Ø Activities to handle post-disaster outbreaks

Ø Communication and transportation improvements that do not impede logistics and health staff mobilization

Ø Health crisis budget allocation from central government and other parties

Ø Disaster area mapping and contingency plan establishment Ø Capacity building for health staff and the community through

training, technical assistance and promotion


Page 28

Ø Facility rehabilitation and reconstruction

Ø Disaster information system establishment Ø Developing safe communities using a holistic approach to risk

management

Ø Logistic supplies in each province

8. Application of lessons learnt from the tsunami – 2

Issues in Pandemic Preparedness

Prevention of outbreaks and epidemics was a key achievement of the disaster response to the tsunami. The success was partially accredited to the prompt establishment of surveillance and reporting systems for communicable diseases in combination with appropriate responses within affected countries. The system established during this time in Aceh was transplanted to Yogyakarta and Central Java following the 27 May earthquake. Trained staff from the surveillance system in the tsunami-affected areas of Indonesia were tapped for sharing expertise and experience. Specific risk assessments were conducted prior to initiation of the system.

Principles of influenza pandemic preparedness can be found in the differentiation of phases of pandemic alert. In times of no discernable pandemic, the inter-pandemic period, there are two phases: Phase I when there is no new influenza virus sub-type and Phase II when there is also no new influenza virus sub-type but there is a risk of transmission from animals. The Pandemic Alert Phase will follow if Phase III occurs with the rare instances of infection in humans with no sustained human-to-human transmission. Phase IV involves clusters with limited and localized spread and a virus not fully adapted to humans. Phase V is characterized by larger clusters, but the virus is still not fully adapted to humans. The Pandemic Phase is marked by increasing and continuous spread of infection to the community on a large scale followed by the Post-Pandemic Phase and return to the inter-pandemic period.

Strategies for pandemic preparedness include:

Ø HPAI Control in animals Ø Epidemiological surveillance in animals and humans


Page 29

Ø Management of human cases of AI

Ø Protection of high risk groups Ø Risk communication and public awareness


Ø Action Research

Ø Strengthening supporting laws (IHR-2005)

Ø Monitoring and Evaluation Ø Developing preparedness and contingency plans

When compared to pandemic preparedness, key points from the tsunami response and recovery include the necessity for appropriate, efficient, community-based epidemiological surveillance in animals and humans in combination with an effective reporting system. Coordination with other sectors is crucial in preparedness and contingency planning, particularly in the animal and agriculture sectors. Logistics activities can be supported with capacity building, purchase of personal protective equipment if needed and distribution and stockpiling SYSTEMS. Contingency planning is supported through scenario building based on health intelligence. It is also important to remember that the pandemic scenario is fast evolving and varied and preparedness plans must be responsive to changing conditions.

9. Group sessions – 1: Determining progress in benchmarks with regard to complex emergencies

The participants were divided into four groups. The groups discussed the progress in benchmarks in the Region, and the best way forward, in the following four areas:

Ø Multisectoral coordination

Ø Community empowerment


Ø Standards and guidelines


Page 30

Out

com

es:

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Mul

tisec

tora

l coo

rdin

atio

n

Lega

l fra

mew

ork

and

func

tioni

ng

coor

dina

tion

mec

hani

sms a

nd

an o

rgan

izat

iona

l st

ruct

ure

in p

lace

fo

r hea

lth E

PR a

t al

l lev

els i

nvol

ving

al

l sta

keho

lder

s

1. IN

D –

DM

A ha

s int

egra

ted

14

maj

or se

ctor

s inc

ludi

ng h

ealth

gi

ving

equ

al e

mph

asis

to 1

4 se

ctor

s (he

alth

, sam

e st

atus

as

defe

nce)

2. B

AN –

Min

istry

of D

M (s

ince

19

92);

Nat

iona

l disa

ster

co

ordi

natio

n co

mm

ittee

(hea

ded

by P

M) –

Min

ister

of H

ealth

is a

m

embe

r of t

he c

omm

ittee

and

at

dist

rict l

evel

it is

led

by th

e lo

cal

govt

and

rura

l dev

elop

men

t (ci

vil

adm

inist

ratio

n) –

mai

n w

ork

is to

en

hanc

e su

rvei

llanc

e

3. B

AN –

for A

I – th

ree

min

istrie

s in

the

fore

front

– M

inist

ry o

f en

viro

nmen

t; po

ultry

and

liv

esto

ck m

inist

ry (d

oing

surv

) fo

llow

ed b

t MO

H b

ehin

d th

em;

4. IN

O –

new

– n

atl c

oord

n bo

ard

for D

M c

haire

d by

Vic

e Pr

esid

ent

(mod

ifica

tion

of o

ld sy

stem

) New

–

vice

cha

irman

– c

oord

inat

ion

min

istry

for p

eopl

es w

elfa

re; 5

/6

1. IN

D/B

AN: R

ealiz

atio

n of

in

crea

sed

vuln

erab

ility

as

a re

sult

of re

peat

ed

disa

ster

s and

aw

aren

ess

of m

iserie

s – re

aliz

atio

n th

at ri

sk re

duct

ion,

pr

even

tion

and

miti

gatio

n w

ere

esse

ntia

l el

emen

ts o

f pr

epar

edne

ss a

nd

mec

hani

sms a

re

requ

ired

to k

eep

the

syst

em o

n tra

ck

2. IN

D: H

eavy

eco

nom

ic

cost

of d

amag

es a

nd

reco

nstru

ctio

n ef

forts

3. B

AN –

epi

dem

ic

outb

reak

s (eg

dia

rrho

ea)

was

the

mot

ivat

ion

4. B

AN –

bot

h pa

rty in

po

wer

and

opp

ositi

on

supp

ort

1. B

AN –

misc

oord

inat

ion

and

apat

hy a

t gra

ssro

ot

leve

l; co

mm

unic

atio

n an

d lo

gist

ics p

robl

ems

2. M

AV –

lack

of t

rain

ed

peop

le in

this

sect

or

3. M

AV –

EPR

foca

l poi

nt

in M

OH

.

4. IN

D/T

HA/

BAN

– L

ong

time

take

n fo

r mak

ing

lega

l cha

nges

; Ted

ious

pa

rliam

enta

ry

proc

edur

es

5. N

EP –

EH

A co

llabo

rate

s pr

imar

ily w

ith th

e Ep

idem

iolo

gy &

Dise

ase

Con

trol D

ivisi

on o

f the

D

epar

tmen

t of H

ealth

Se

rvic

es.

The

divi

sion

has n

o st

aff

allo

cate

d to

disa

ster

m

anag

emen

t or r

isk

miti

gatio

n. In

stitu

tiona

lly,

it re

mai

ns a

wea

k se

tup

In N

epal

, a sp

ecia

l cha

pter

on

disa

ster

man

agem

ent

was

incl

uded

in th

e 10

th

Five

Yea

r Pla

n bu

t the

re is

lit

tle in

dica

tion

of

subs

tant

ial i

mpa

ct.

WH

O is

in th

e pr

oces

s of

esta

blish

ing

an E

mer

genc

y M

edic

al W

orki

ng G

roup

to

inst

itutio

naliz

e a

mas

s ca

sual

ty m

anag

emen

t sy

stem

in th

e co

untry

.


Page 31

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

agen

cies

repr

esen

ted

incl

ude

MO

H a

nd th

e ar

my

5. D

isast

er la

w –

dra

ft is

awai

ting

parli

amen

tary

app

rova

l

6. M

AV –

no

law

, nat

iona

l DM

ce

ntre

set u

p af

ter t

suna

mi b

y Pr

esid

entia

l dec

ree–

lead

by

defe

nce

and

natio

nal s

ecur

ity

7. U

nits

for h

ousin

g, p

rovi

sion

for

IDPs

, hea

lth

8. N

ot re

ally

func

tiona

l – th

e un

its

wor

k th

roug

h re

spec

tive

line

min

istrie

s, no

t thr

ough

the

ND

M

cent

re

9. M

AV –

Dra

ft na

tiona

l disa

ster

m

anag

emen

t pla

n. T

here

is a

se

para

te D

efen

ce M

inist

ry P

lan.

Th

e he

alth

sect

or p

lan

is no

t in

tegr

ated

into

the

natio

nal

disa

ster

man

agem

ent p

lan.

But

no

w th

e M

inist

ry o

f Hea

lth is

par

t of

the

stru

ctur

e of

the

Nat

iona

l D

isast

er M

anag

emen

t Cen

tre.

10. S

RL –

upd

atin

g th

e ex

istin

g m

enta

l hea

lth la

w

11. T

HA

– H

as a

Civ

il D

isast

er A

ct

whi

ch is

15

year

s old

–ne

w A

ct

for a

mul

ti-fa

cette

d EH

A pr

ogra

mm

e. E

HA

prog

ram

me

shou

ld b

e es

tabl

ished

in th

e m

inist

ry to

add

ress

pol

icy

and

hosp

ital i

ssue

s.


Page 32

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

is pe

ndin

g pa

rliam

ent a

ppro

val –

PM

as c

hairp

erso

n –

Act

expe

cted

to im

prov

e co

ordi

natio

n in

big

disa

ster

–

chan

ge o

rgan

izat

iona

l stru

ctur

e;

Ever

y th

ree

year

s the

PO

A w

ill

be re

view

ed (t

his y

ear w

ill b

e th

e re

view

yea

r)

12. N

EP: D

isast

er P

repa

redn

ess L

aw

bein

g re

vise

d. W

HO

has

re

cent

ly e

stab

lishe

d an

Em

erge

ncy

Hea

lth a

nd N

utrit

ion

Wor

king

Gro

up to

faci

litat

e co

ordi

natio

n w

ith o

pera

tiona

l ag

enci

es in

the

sect

or.

Emer

genc

y fin

anci

al (i

nclu

ding

na

tiona

l bud

get),

ph

ysic

al a

nd

regu

lar h

uman

re

sour

ce a

lloca

tion

and

acco

unta

bilit

y pr

oced

ures

es

tabl

ished

1. B

AN –

fund

allo

cate

d fo

r disa

ster

fro

m re

gula

r gov

t bud

get;

augm

ente

d by

EB

reso

urce

s fro

m

dono

rs; H

uman

Res

ourc

es a

nd

phys

ical

spac

e av

aila

ble

2. T

HA

– Li

ne o

f cre

dit e

xten

ded

to

gove

rnor

s fro

m C

entra

l Fun

d (a

bout

50

m b

ahts

per

eve

nt)

3. T

HA

– hu

man

cap

acity

dev

elop

ed

in th

e ar

ea o

f ide

ntifi

catio

n of

de

ad b

odie

s

1. IN

D –

law

has

faci

litat

ed

the

proc

ess

2. M

AV –

all

volu

ntar

y co

ntrib

utio

ns re

ceiv

ed

from

the

priv

ate

sect

or

afte

r the

tsun

ami h

ave

been

put

into

a sp

ecifi

c ac

coun

t by

the

gove

rnm

ent,

with

a

boar

d ap

poin

ted

by th

e Pr

esid

ent t

o ad

min

ister

th

e fu

nds.

1. M

AV –

lack

of f

unds

and

tra

ined

peo

ple.

No

fund

s ha

ve b

een

allo

cate

d to

the

natio

nal b

udge

t for

EPR

2. B

AN –

no

reta

inin

g of

tra

ined

peo

ple

3. N

EP –

Lac

k of

su

bsta

ntia

l bud

get t

o re

duce

the

vuln

erab

ility

of

the

heal

th

infra

stru

ctur

e in

Nep

al; a

pu

blic

hea

lth p

riorit

y in

vi

ew o

f the

seism

ic ri

sk.

NEP

– R

efle

ctin

g th

e al

loca

tion

of re

sour

ces,

disa

ster

man

agem

ent i

s of

ten

view

ed a

s don

or /

NG

O b

usin

ess a

mon

g go

vern

men

t offi

cial

s in

Nep

al.


Page 33

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

4. IN

D –

Act

has

put

in p

lace

a

natio

nal c

entre

of e

xcel

lenc

e (N

IDM

) and

Nat

iona

l Disa

ster

Re

lief F

und

and

disa

ster

m

itiga

tion

fund

set u

p

5. M

AV –

No

EPR

fund

s in

budg

et.

How

ever

, Min

istry

of H

ealth

has

id

entif

ied

fund

s for

EPR

act

iviti

es.

Fund

s for

shor

t-ter

m tr

aini

ng in

w

aste

man

agem

ent a

nd d

isast

er

prep

ared

ness

rece

ived

from

ts

unam

i fun

ding

6. N

EP –

For

the

first

tim

e, M

inist

ry

of H

ealth

and

Pop

ulat

ion

has

allo

cate

d a

min

imal

bud

get t

o in

itiat

e no

n-st

ruct

ural

miti

gatio

n of

Bha

ktap

ur h

ospi

tal i

n th

e Ka

thm

andu

val

ley.

7. IN

D –

Pos

t-tsu

nam

i – c

ore

grou

p es

tabl

ished

in P

lann

ing

Com

mis-

sion

to o

vers

ee re

habi

litat

ion

and

reco

nstru

ctio

n; D

edic

ated

am

ount

of m

oney

from

nat

iona

l bu

dget

to b

e ea

rmar

ked

for f

utur

e em

erge

ncie

s too

8. IN

D –

est

ablis

hed

natio

nal

disa

ster

resp

onse

cou

rse

– 10

,000

pe

ople

(cen

tral p

aram

ilita

ry

forc

es) b

eing

trai

ned

for D

M


Page 34

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Rule

s of

enga

gem

ent

(incl

udin

g co

nduc

t) fo

r ex

tern

al

hum

anita

rian

agen

cies

bas

ed o

n ne

eds e

stab

lishe

d

1. IN

D –

pol

icy

deci

sión

– do

esn’

t ne

ed h

uman

itaria

n as

sista

nce;

lo

ans f

rom

mul

tilat

eral

age

ncie

s lik

e AD

B an

d W

B w

elco

me

for

reha

bilit

atio

n an

d re

cons

truct

ion

2. B

AN –

aid

to N

GO

s has

to b

e ch

anne

lled

thro

ugh

the

Nat

iona

l N

GO

Bur

eau

3. M

AV –

all

hum

anita

rian

aid

coor

dina

ted

thro

ugh

dept

of

exte

rnal

reso

urce

s

4. N

EP –

The

issu

e of

trig

ger f

acto

rs

for h

uman

itaria

n in

terv

entio

ns

and

enha

nced

con

tinge

ncy

plan

ning

wer

e di

scus

sed

at a

UN

O

CH

A co

ntin

genc

y pl

anni

ng

wor

ksho

p (A

pril

2006

).

As fo

r the

hea

lth se

ctor

, WH

O

purs

ues c

ontin

genc

y pl

anni

ng in

the

Emer

genc

y H

ealth

and

Nut

ritio

n W

orki

ng G

roup

and

the

Emer

genc

y M

edic

al W

orki

ng G

roup

.

1. D

eleg

atio

n of

m

onito

ring

to lo

cal

subo

rdin

ate

staf

f (IN

O)

2. P

erm

ittin

g tim

e bo

und

oper

atio

n of

hu

man

itaria

n ac

tors

(IN

O)

1. C

apac

ity c

onst

rain

ts fo

r m

onito

ring

and

regu

latio

n (M

AV)

2. N

EP –

The

sect

oral

w

orki

ng g

roup

s for

med

in

199

3 (F

ood

&

Agric

ultu

re, L

ogist

ics a

nd

Hea

lth) n

eeds

to b

e re

vita

lized

and

ex

pand

ed to

faci

litat

e se

ctor

al c

oord

inat

ion

amon

g U

N, g

over

nmen

t, do

nors

, int

erna

tiona

l or

gani

zatio

ns a

nd

NG

Os.

The

activ

e ye

ars

of th

e D

isast

er H

ealth

W

orki

ng G

roup

(200

1-20

04) c

ould

serv

e as

an

exam

ple

of b

est

prac

tice.

Gro

up c

onsid

ered

onl

y hu

man

itaria

n re

lief p

hase

NEP

– O

CH

A to

pla

y a

key

role

in m

anag

ing

expe

cted

in

flow

of h

uman

reso

urce

s an

d do

natio

ns in

the

even

t of

a m

ajor

em

erge

ncy.

C

onsid

erin

g th

e lim

ited

capa

city

of T

ribhu

van

Inte

rnat

iona

l Airp

ort,

it is

vita

l to

prep

are

'tria

ge'

proc

edur

es to

sort

esse

ntia

l su

pplie

s fro

m n

on-e

ssen

tial

dona

tions

.


Page 35

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Com

mun

ity E

mpo

wer

men

t

Com

mun

ity p

lan

for m

itiga

tion,

pr

epar

edne

ss a

nd

resp

onse

de

velo

ped,

bas

ed

on ri

sk

iden

tific

atio

n an

d pa

rtici

pato

ry

vuln

erab

ility

as

sess

men

t and

ba

cked

by

a hi

gher

le

vel o

f cap

acity

IFRC

, ‘lis

teni

ng’ p

roje

ct a

fter

Tsun

ami;

with

loca

l Pal

ang

Mer

ah,

Indo

nesia

(PM

I), In

done

sian

Red

Cro

ss.

BHU

: new

disa

ster

man

agem

ent

syst

em fr

om th

e to

p do

wn

to v

illag

e le

vel.

(ear

ly 2

006)

.

NEP

: WH

O p

lans

to e

ngag

e at

co

mm

unity

leve

l as p

art o

f the

up

com

ing

Con

solid

ated

App

eal

Proc

ess (

CAP

) pro

gram

me

to b

e im

plem

ente

d du

ring

THE

seco

nd

half

of th

e ye

ar. F

our t

arge

t dist

ricts

in

the

coun

try w

ill b

e ch

osen

and

co

mm

unity

inte

rven

tions

pro

pose

d in

col

labo

ratio

n w

ith p

artn

ers.

THA:

Def

ence

vol

unte

ers f

orm

at

leas

t 1%

of t

he p

opul

atio

n

The

com

mun

ity-b

ased

disa

ster

risk

m

anag

emen

t pro

gram

me

is no

w

wor

king

in m

ore

than

300

vill

ages

In In

done

sia, L

ocal

PM

I st

aff a

nd c

hapt

ers a

re

resid

ent a

nd (c

ultu

rally

aw

are

and

can

spea

k th

e lo

cal l

angu

age)

.

Trai

ning

of T

rain

ers t

ook

plac

e in

Ace

h, d

istric

t lev

el

coor

dina

tion

and

villa

ge/

com

mun

ity E

PR.

NEP

: The

com

plex

em

erge

ncy

in N

epal

has

, fo

r a lo

ng ti

me,

lim

ited

acce

ss to

the

field

. Afte

r th

e de

moc

ratic

revo

lutio

n in

Apr

il 20

06 a

nd th

e su

bseq

uent

pea

ce-

agre

emen

t bet

wee

n th

e Se

ven

Party

Alli

ance

and

th

e C

PN(M

), it

is cu

rren

tly

rela

tivel

y ea

sy to

mov

e to

th

e fie

ld.

NEP

: UN

DP,

WFP

, GTZ

an

d se

vera

l NG

Os

are

wor

king

on

haza

rd

map

ping

and

risk

m

itiga

tion

at th

e co

mm

unity

leve

l.


Page 36

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Com

mun

ity-b

ased

re

spon

se a

nd

prep

ared

ness

ca

paci

ty

deve

lope

d,

supp

orte

d w

ith

train

ing

and

regu

lar s

imul

atio

n/

moc

k dr

ills

PMI A

ceh

has s

et u

p lo

cal ‘

liste

ning

pr

ojec

t’.

In S

ri La

nka,

pub

lic h

ealth

insp

ecto

r an

d fe

mal

e vi

llage

hea

lth w

orke

r (m

idw

ife) w

ere

train

ed o

n va

rious

as

pect

s of c

omm

unity

pre

pare

dnes

s

In N

epal

, thi

s is o

ne o

f the

ob

ject

ives

of t

he u

pcom

ing

WH

O

CAP

pro

gram

me.

Rap

id re

spon

se

team

s will

be

train

ed in

hu

man

itaria

n m

onito

ring

and

resp

onse

and

equ

ippe

d w

ith

esse

ntia

l sup

plie

s.

In T

haila

nd, s

ub-d

istric

t sea

rch

and

resc

ue te

ams c

over

all

area

s.

Tr

aditi

onal

CBO

s hav

e a

pote

ntia

l but

do

not a

lway

s re

aliz

e th

eir a

dditi

onal

role

s

Espe

cial

ly, t

heir

pote

ntia

l fo

r rel

igio

us e

ntiti

es.

Con

sider

ing

that

the

MU

STER

softw

are

need

s to

be p

hase

d ou

t soo

n, it

is

nece

ssar

y to

inve

st in

new

, at

tract

ive

train

ing

mod

aliti

es to

kee

p up

the

high

pro

file

of th

e pr

ogra

mm

e in

Nep

al.

WH

O N

epal

has

rece

ntly

pu

blish

ed n

ew m

ass

casu

alty

man

agem

ent

train

ing

guid

elin

es

sum

mar

izin

g le

sson

s le

arne

d du

ring

prev

ious

ye

ars.

Loca

l cap

acity

for

emer

genc

y pr

ovisi

on o

f es

sent

ial s

ervi

ces

and

supp

lies

(shel

ters

, saf

e dr

inki

ng w

ater

, fo

od,

com

mun

icat

ion)

de

velo

ped

Gan

dhig

ram

Rur

al In

stitu

te tr

aine

d co

mm

unity

in w

atsa

n

Prov

ided

repl

acem

ent s

ervi

ces i

n th

e te

mpo

rary

shel

ters

whi

ch w

ere

late

r also

ado

pted

in n

eigh

bour

ing

villa

ges

Nep

al: W

HO

/ U

NIC

EF /

UN

FPA

cond

ucte

d a

coun

try-w

ide

asse

ssm

ent o

f 33

hosp

itals'

mas

s ca

sual

ty m

anag

emen

t res

pons

e ca

paci

ty d

urin

g an

d sh

ortly

afte

r the

Com

mun

ity re

aliz

ed ri

sks

afte

r aw

aren

ess c

amps

Resid

ual c

hlor

ine

test

ing,

gu

idel

ines

on

solid

was

te

man

agem

ent,

drai

nage

, etc

Doc

umen

tatio

n an

d pr

epar

atio

n of

a te

chni

cal

man

ual

In v

iew

of t

he v

ulne

rabl

e (h

ealth

) inf

rast

ruct

ure

with

lim

ited

resp

onse

cap

acity

,

In

Nep

al, S

ever

al U

N

agen

cies

and

com

mun

ities

ha

ve p

re-p

ositi

oned

es

sent

ial s

uppl

ies a

nd

equi

pmen

t for

em

erge

ncy

resp

onse

.

UN

ICEF

is c

urre

ntly

dril

ling

5 se

ismic

safe

bor

ehol

es

and

wat

er tr

eatm

ent

faci

litie

s in

Lalit

pur

Mun

icip

ality

(Kat

hman

du


Page 37

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

culm

inat

ion

of th

e de

moc

ratic

m

ovem

ent i

n Ap

ril 2

003.

Pre-

posit

ioni

ng o

f ess

entia

l sup

plie

s an

d eq

uipm

ent i

n ta

rget

dist

ricts

an

d in

Kat

hman

du is

ano

ther

co

mpo

nent

of t

he W

HO

CAP

pr

ogra

mm

e, w

hich

is in

the

proc

ess

of b

eing

impl

emen

ted.

Supp

ly M

anag

emen

t (S

UM

A) /

Logi

stic

Sup

ply

Man

agem

ent (

LSM

) wou

ld

be a

n im

porta

nt tr

aini

ng

pack

age

to in

trodu

ce to

N

epal

.

Valle

y) fo

r sup

ply

of

drin

king

wat

er in

the

even

of

a m

ajor

ear

thqu

ake.

Cap

acity

Bui

ldin

g

Advo

cacy

and

aw

aren

ess

deve

lope

d th

roug

h ed

ucat

ion,

in

form

atio

n m

anag

emen

t and

co

mm

unic

atio

n (p

re-,

durin

g an

d po

st-e

vent

)

Mya

nmar

:

• Tr

aini

ng o

f tra

iner

s (to

cre

ate

awar

enes

s at t

he g

rass

root

s lev

el

in th

e co

mm

unity

)

• Ad

voca

cy to

com

mun

ity le

vel

utili

zing

med

ia a

nd c

omm

unity

m

embe

rs

• Tr

aini

ng c

ours

es c

ondu

cted

in

loca

l lan

guag

es

Indi

a:

• Po

litic

al se

nsiti

zatio

n

• Tr

aini

ng o

f com

mun

ity in

a v

ery

com

preh

ensiv

e w

ay (r

egar

ding

ba

sic so

cial

serv

ices

mor

e th

an

1700

0 vi

llage

s)

• H

igh-

leve

l pol

itica

l co

mm

itmen

t

• N

GO

col

labo

ratio

n (w

ith

advo

cacy

, inv

olve

men

t &

aw

aren

ess

prog

ram

me,

esp

. whe

re

need

s req

uire

men

t are

id

entif

ied

and

mat

eria

ls ar

e pr

epar

ed

acco

rdin

gly)

• In

ter-

sect

oral

co

ordi

natio

n

• D

ocum

enta

tion

and

info

rmat

ion

man

agem

ent

• La

ngua

ge b

arrie

rs

(ado

ptin

g th

e tra

inin

g in

di

ffere

nt la

ngua

ges t

o in

volv

e th

e co

mm

uniti

es

at la

rge)

• Re

sour

ces:

fund

al

loca

tion

for e

mer

genc

y sit

uatio

ns

• H

uman

reso

urce

ca

paci

ty in

cul

tura

l and

la

ngua

ge a

war

enes

s

Nep

al: T

he c

halle

nge

is to

m

ove

out o

f the

Ka

thm

andu

Val

ley

and

addr

essin

g lo

cal r

isk

man

agem

ent a

nd

Nep

al:

Awar

enes

s of r

isk

man

agem

ent a

nd

miti

gatio

n is

rela

tivel

y hi

gh

in th

e Ka

thm

andu

Val

ley

due

to su

stai

ned

effo

rts fo

r ye

ars.

The

chal

leng

e is

to

build

on

awar

enes

s lea

ding

to

con

cret

e ac

tion.

We

wou

ld li

ke to

add

m

edia

rela

tions

in th

is ex

istin

g be

nchm

ark

as it

is

impo

rtant

in a

dvoc

acy

as

wel

l as a

trai

ning

tool

Advo

cacy

and

aw

aren

ess

deve

lope

d th

roug

h ed

uca-

tion,

info

rmat

ion


Page 38

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Sri L

anka

:

• D

istric

t Disa

ster c

oord

inat

ors

appo

inte

d (d

ecen

traliz

atio

n)

• U

nit d

edic

ated

to d

isaste

r pr

epar

edne

ss

• St

reng

then

ing

of th

e ex

istin

g su

rvei

llanc

e sy

stem

(im

prov

ed th

e re

porti

ng sy

stem

from

gra

ssro

ot

leve

l to

natio

nal l

evel

)

Nep

al:

An in

tegr

al p

art o

f the

WH

O E

HA

pres

ence

in N

epal

.

WH

O p

lans

to e

ngag

e m

ore

activ

ely

in a

dvoc

acy

and

awar

enes

s at

com

mun

ity le

vel a

s par

t of t

he C

AP

prog

ram

me.

Mal

dive

s:

Disa

ster m

anag

emen

t is t

o be

in

corp

orat

ed in

the

scho

ol

curri

culu

m.

hum

anita

rian

chal

leng

es in

re

mot

e lo

catio

ns.

Mal

dive

s: c

halle

nge

is ca

paci

ty b

uild

ing

of a

ll te

ache

rs a

t all

leve

ls

man

agem

ent a

nd c

omm

u-ni

catio

n, in

clud

ing

effe

ctiv

e m

edia

rela

tions

(p

re-,

durin

g an

d po

st-

even

t)

Cap

acity

to

iden

tify

risks

and

as

sess

vul

nera

bilit

y at

all

leve

ls es

tabl

ished

Indi

a:

• N

atio

n w

ide

surv

eilla

nce

syst

em

up to

the

gras

sroo

ts le

vel

esta

blish

ed

• Av

aila

bilit

y of

rele

vant

to

ols a

nd g

uide

lines

for

vuln

erab

ility

ass

essm

ent

• H

avin

g a

prim

ary

heal

th

care

syst

em

• Al

thou

gh h

uman

reso

urce

ca

paci

ty is

ava

ilabl

e in

so

me

coun

tries

of t

he

Regi

on, s

ome

coun

tries

do

not

hav

e ad

equa

te

hum

an re

sour

ce

Build

ing

capa

city

at t

he

com

mun

ity le

vel a

nd lo

cal

capa

city

Raisi

ng c

urre

nt h

uman

re

sour

ce c

apac

ity in

Bi a

nd

mul

ti-lin

gual

abi

lity


Page 39

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Mya

nmar

:

• Vu

lner

abili

ty a

nd ri

sk m

appi

ng

Nep

al:

WH

O is

cur

rent

ly p

repa

ring

an

asse

ssm

ent o

f the

Nat

iona

l Pub

lic

Hea

lth L

abor

ator

y an

d ce

ntra

l /

regi

onal

blo

od b

anks

in

colla

bora

tion

with

NSE

T-N

epal

.

Epid

emio

logy

and

Dise

ase

Con

trol

Div

ision

(ED

CD

) / D

epar

tmen

t of

Hea

lth S

ervi

ces (

DH

S), W

HO

Nep

al

and

NSE

T-N

epal

hav

e se

ismic

ally

as

sess

ed 1

4 ho

spita

ls th

roug

hout

the

coun

try.

Mal

dive

s

• D

isast

er R

isk A

sses

smen

t rep

ort

publ

ished

in Ju

ne 2

006

• Ri

sk a

sses

smen

t is s

trong

at c

entra

l le

vel

• In

ter-

sect

oral

co

llabo

ratio

n (M

oH is

cl

osel

y w

orki

ng w

ith

DAR

in S

ri La

nka)

• H

uman

reso

urce

av

aila

bilit

y (In

dia

)

• In

Nep

al, t

he re

al

chal

leng

e is

to c

onve

rt th

e se

ismic

ass

essm

ents

in

to a

ctio

ns in

term

s of

miti

gatio

n m

easu

res.

• In

the

Mal

dive

s, de

cent

raliz

ing

risk

and

vuln

erab

ility

ass

essm

ent

is a

chal

leng

e

• Th

ere

is a

lack

of

prof

essio

nal c

apac

ity in

th

is ar

ea in

the

Mal

dive

s, an

d ca

paci

ty b

uild

ing

is ne

eded

.

Hum

an re

sour

ce

capa

bilit

ies

cont

inuo

usly

up

date

d an

d m

aint

aine

d

• Tr

aini

ng o

n m

ass c

asua

lty

man

agem

ent a

s wel

l as p

ublic

he

alth

man

agem

ent

• In

Nep

al, o

nly

the

PEER

pr

ogra

mm

e ha

s an

effe

ctiv

e sy

stem

of u

pdat

ing

train

ed h

uman

• In

tegr

atio

n of

diff

eren

t di

sast

er m

anag

emen

t pl

ans f

rom

diff

eren

t ho

spita

ls in

to th

e na

tiona

l disa

ster

m

anag

emen

t pla

n

• C

halle

nges

in b

ilate

ral

com

mitm

ent

• Fr

eque

nt tr

ansfe

r of

gove

rnm

ent s

taff

and

poor

com

mun

icat

ion

mak

es it

a c

halle

ngin

g

To h

ave

rost

ers o

f tho

se

train

ed a

t ins

titut

iona

l lev

el

and

mak

e th

em a

vaila

ble

for o

ther

Mem

ber

coun

tries

to ta

p w

hene

ver

nece

ssar

y


Page 40

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

reso

urce

s in

thei

r res

pect

ive

cour

ses.

• In

the

Mal

dive

s, ca

paci

ty b

uild

ing

of h

ealth

care

wor

kers

in d

isast

er

man

agem

ent,

life-

supp

ort c

are,

pu

blic

hea

lth e

mer

genc

ies,

pre-

hosp

ital c

are

and

hosp

ital

emer

genc

y pr

epar

edne

ss is

on

goin

g.

• C

apac

ity b

uild

ing

of th

e co

mm

unity

in fi

rst-a

id a

nd

psyc

hoso

cial

firs

t-aid

is a

lso

ongo

ing

in th

e M

aldi

ves.

task

to tr

ace

the

peop

le

who

hav

e be

en tr

aine

d th

roug

h th

e ye

ars.

• Ap

poin

ting

peop

le

havi

ng th

ese

capa

bilit

ies

to d

iffer

ent a

reas

is a

ch

alle

nge.

• D

ue to

the

uniq

ue

geog

raph

ical

dist

ribut

ion

of th

e M

aldi

ves,

it is

a ch

alle

nge

to tr

ain

hum

an

reso

urce

s to

be a

vaila

ble

at a

ll le

vels

requ

ired

(i.e.

na

tiona

l, at

oll a

nd is

land

le

vels)

.

• Re

tain

ing

heal

thca

re

wor

kers

who

hav

e be

en

train

ed in

diff

eren

t are

as

of d

isast

er m

anag

emen

t is

also

a c

halle

nge.


Page 41

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Stan

dard

s an

d G

uide

lines

Regu

larly

upd

ated

di

sast

er

prep

ared

ness

and

em

erge

ncy

man

agem

ent p

lan

for h

ealth

sect

or

and

SOPs

(e

mer

genc

y di

rect

ory,

nat

iona

l co

ordi

natio

n fo

cal

poin

t) in

pla

ce

• Al

l cou

ntrie

s in

the

Regi

on h

ave

disa

ster

man

agem

ent p

lans

exc

ept

DPR

K an

d Ti

mor

-Les

te

• In

Nep

al, W

HO

SO

Ps u

nder

pr

epar

atio

n an

d an

Em

erge

ncy

Con

trol R

oom

in th

e m

akin

g.

• A

disa

ster

man

agem

ent

plan

act

s as a

n ad

voca

cy

and

awar

enes

s too

l. Bu

t ad

voca

cy a

nd a

war

enes

s bu

ildin

g is

also

nee

ded

to c

onvi

nce

polic

y-m

aker

s to

form

ulat

e a

plan

.

• Al

ong

with

a p

lan,

re

gula

r dril

ls he

lp in

the

impl

emen

tatio

n.

• C

apac

ity to

resp

ond

mus

t mat

ch p

lan

• Pl

an n

eeds

to b

e re

gula

rly u

pdat

ed, b

ut

this

may

be

diffi

cult.

It

may

be

bette

r if t

he p

lan

rem

ains

, but

if S

OPs

are

ch

ange

d ac

cord

ing

to

the

cont

ext.

• In

Nep

al, a

hea

lth se

ctor

em

erge

ncy

plan

has

be

en p

repa

red

by th

e m

ulti-

agen

cy D

isast

er

Hea

lth W

orki

ng G

roup

fro

m 2

001

to 2

003.

U

nfor

tuna

tely

, not

op

erat

iona

l and

not

in

tegr

ated

into

the

heal

th sy

stem

.

In N

epal

, the

dyn

amic

D

isast

er H

ealth

Wor

king

G

roup

Sec

reta

riat b

ecam

e in

activ

e af

ter D

HS

/ ED

CD

to

ok o

ver t

he le

ader

ship

an

d fo

rmal

ized

the

mee

tings

.

Hea

lth fa

cilit

ies

built

/mod

ified

to

with

stan

d ex

pect

ed ri

sks

Mal

dive

s-H

ealth

faci

litie

s are

one

st

orey

pre

viou

sly b

ut n

ow tw

o st

orie

s. Re

cord

s and

equ

ipm

ent k

ept

on th

e se

cond

floo

r – fl

oods

Thai

land

-Hos

pita

l with

hig

h flo

ors

crea

te a

n en

viro

nmen

t whi

ch is

co

nduc

ive

to c

omm

it su

icid

e

Gov

ernm

ent n

eeds

to

impl

emen

t bui

ldin

g co

des

Bang

lade

sh-R

isk

asse

ssm

ent d

one-

tidal

flo

ws i

n th

e So

uth,

ea

rthqu

akes

in th

e N

orth

Build

ing

prac

tices

bel

ow

stan

dard

s/cod

es.

Fund

ing

is a

criti

cal i

ssue

Expe

nsiv

e to

retro

fit

hosp

itals

Hig

her b

uild

ing

for s

choo

ls an

d ho

spita

ls re

quire

d


Page 42

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Cyc

lone

shel

ters

bui

lt in

Ba

ngla

desh

-320

0 sh

elte

rs

(Sch

oolte

rs-S

choo

l she

lters

)

In N

epal

, as p

art o

f the

CAP

pr

ogra

mm

e, W

HO

pla

ns to

initi

ate

non-

stru

ctur

al m

itiga

tion

of st

rate

gic

heal

th fa

cilit

ies (

poss

ibly

Bir

Hos

pita

l an

d Te

achi

ng H

ospi

tal)

thro

ugh

the

seco

nd h

alf o

f the

yea

r.

Nep

al –

seism

ic

asse

ssm

ents

of 1

4 ho

spita

ls ca

rrie

d ou

t for

safe

ty

Tech

nica

l ass

istan

ce

rega

rdin

g st

ruct

ural

m

odifi

catio

n

Subs

tant

ial i

nves

tmen

ts a

re

need

ed to

impr

ove

the

seism

ical

ly v

ulne

rabl

e he

alth

infra

stru

ctur

e in

the

coun

try. D

espi

te W

HO

an

d pa

rtner

s org

aniz

ing

a do

nor m

eetin

g, n

o do

nors

ha

ve c

ome

forw

ard.

In N

epal

, bui

ldin

g co

des

have

offi

cial

ly b

een

appr

oved

but

are

not

be

ing

impl

emen

ted.

Nee

ds

to b

e di

scus

sed

with

the

Div

ision

of U

rban

D

evel

opm

ent a

nd B

uild

ing

Con

stru

ctio

n, D

epar

tmen

t of

Phy

sical

Pla

nnin

g W

orks

.

Early

war

ning

and

su

rvei

llanc

e sy

stem

s for

id

entif

ying

hea

lth

conc

erns

es

tabl

ished

Mal

dive

s-D

iscus

sion

and

plan

ning

fo

r ear

ly w

arni

ng sy

stem

-co

mm

unic

atio

n ar

rang

emen

t- th

roug

h th

e sa

telli

te sy

stem

Bang

lade

sh-C

PP-C

yclo

ne

prep

ared

ness

pro

gram

me

C

omm

unic

atio

n cu

t off

durin

g th

e Ts

unam

i for

72

hour

s

Nee

d co

mm

unity

bas

ed

early

war

ning

and

su

rvei

llanc

e sy

stem

Join

t Nep

al /

DFI

D m

issio

ns

have

stud

ied

the

issue

of

heal

th sy

stem

func

tiona

lity

and

prop

osed

a m

onito

ring

syste

m th

at a

ny fu

ture

hu

man

itaria

n m

onito

ring

mus

t bui

ld u

pon.


Page 43

Benc

hmar

k C

oncr

ete

exam

ples

of p

rogr

ess

Fact

ors

that

hav

e he

lped

to

ach

ieve

pro

gres

s Ba

rrie

rs to

ach

ievi

ng

prog

ress

O

ther

com

men

ts

Indo

nesia

-SM

S m

essa

ge th

roug

h m

obile

pho

nes

Sire

n sy

stem

in B

ali i

n pl

ace

Bhut

an-G

laci

er b

reak

up-

dow

nstre

am a

utho

ritie

s can

be

info

rmed

(8-1

0 ho

urs)

Thai

land

-300

war

ning

pos

ts a

roun

d th

e co

untry

Villa

ges h

ave

loud

spea

kers

in

Thai

land

Mya

nmar

-Ear

ly w

arni

ng sy

stem

by

the

Dep

artm

ent o

f Met

eoro

logy

and

H

ydro

logy

Nep

al: S

epte

mbe

r 200

5 un

til M

ay

2006

, WH

O a

ttem

pted

to e

stab

lish

an e

arly

war

ning

syst

em b

y ut

ilizi

ng

10 W

HO

fiel

d of

fices

and

m

obili

zing

Sur

veill

ance

Med

ical

O

ffice

rs o

f the

Imm

uniz

atio

n Pr

even

tabl

e D

iseas

e pr

ogra

mm

e.

WH

O p

lans

to in

volv

e th

e C

onfli

ct

& H

ealth

uni

t at t

he L

ondo

n Sc

hool

of

Hyg

iene

and

Tro

pica

l Med

icin

e in

con

cept

ualiz

ing

a ne

w

hum

anita

rian

mon

itorin

g sy

stem

as

part

of th

e C

AP p

rogr

amm

e.

Get

ting

auth

orita

tive

mes

sage

thro

ugh

the

SMS

Cos

t im

plic

atio

ns o

f hig

h-te

ch c

omm

unic

atio

n sy

stem

s-co

st e

ffici

ency

Man

y N

GO

s do

not a

gree

on

Tha

iland

’s ea

rly

war

ning

syst

em-

Unc

lear

def

initi

on o

f ID

Ps

in th

e N

epal

con

text

and

lo

w re

spon

se ra

tes a

t fie

ld

leve

l cha

lleng

ed th

e sy

stem

at

bot

h th

e co

ncep

tual

and

ex

ecut

ion

leve

l.

The

colle

cted

dat

a ha

s lim

ited

valu

e fro

m a

n an

alyt

ical

pub

lic h

ealth

pe

rspe

ctiv

e.

Enha

nced

dise

ase

surv

eilla

nce

is lik

ely

to b

e fu

nded

by

the

Wor

ld B

ank

as p

art o

f the

Avi

an

Influ

enza

con

tinge

ncy

plan

ning

pro

cess

in N

epal

.


Page 44

Comments and Discussion: Most countries have made satisfactory progress on the benchmarks. However, challenges remain, with financial barriers and the lack of appropriately trained human resources being the most important ones.

Some benchmarks have also been revised in order to encompass a wider spectrum. The benchmark on advocacy and awareness has been changed to include media relations and now reads as follows:

‘Advocacy and awareness developed through education, information management and communication, INCLUDING EFFECTIVE MEDIA RELATIONS (pre-, during and post-event)’

10. Group session 2: applying benchmarks to pandemic preparedness

Eight of the 12 benchmarks for disaster management are appropriate for pandemic preparedness.

Benchmark Reasons for selection

Specific Pandemic Preparedness

Activities related to benchmark

Other comments

1. Legal framework and functioning coordination mechanisms and an organizational structure in place for health EPR at all levels involving all stakeholders

• International issue

• Authority, role and responsibility need to be clearly identified

• Legal framework should ensure that within a certain radius chickens should be culled

• Quarantine

• Cross-border issues

• Assist governments in developing the legal framework and the coordination mechanism between different ministries

Take into consideration legal framework already in place

2. Regularly updated disaster prepared-ness and emergency management plan for health sector and SOPs

• Evolving situation

• No time to adapt plan during pandemic

Regular update not sufficient but also simulation and drill exercises Role of military

Specific timeframe for implementing activities, regional commitment Scale, very difficult for


Page 45




Other comments

(emergency directory, national coordination focal point) in place

important Lessons learned from previous pandemics

countries to prepare for pandemic

3. Emergency financial (including national budget), physical and regular human resource allocation and accountability procedures established

• No budget allocated yet

• Budget needs to be spent within short period of time

• Such a system needed for compensation of culled chickens

• Budget needs to be reserved

• Partnerships within country

• Assist in resource mobilization

4. Rules of engagement (including conduct) for external humanitarian agencies based on needs established

Command control essential

Staff needs to be trained to protect themselves

Possibility that few agencies are willing to come.

5. Advocacy and awareness developed through education, information management and communication (pre-, during and post-event)

Education, information essential pre-, during and post-pandemic is needed to create awareness among the community

Should include effective, sustainable use of media.

Communication plan including draft materials

Assist in developing risk communication-health education materials for the community

Regional collaboration on sharing of IEC messages

6. Human resource capabilities continuously updated and maintained

HR may be affected

Capacity building needed to educate the community

Staff need to be trained to protect themselves

Assist in capacity building for development of human resources including training

Possible limited external HR available


Page 46




Other comments

7. Health facilities built/modified to withstand expected risks

Excessive peak demand

Surge capacity No country can be fully prepared

8. Early warning and surveillance systems for identifying health concerns established

Need for proper guidelines for case detection and reporting

Laboratory systems need to be strengthened for surveillance and diagnosis

Assist the government and MOH in developing guidelines for case detection and reporting

Assist in strengthening of laboratory capacity in the health sector

11. Session on partnerships Discussion with Partners

The tsunami was unprecedented in terms of its scale and the overwhelming response it evoked. Over 80% of WHO’s appeal was funded. The main areas funded included:

Ø Health policy and coordination

Ø Health protection and disease prevention

Ø Provision of essential health services

Ø Arranging medical supplies

In a review of funding policies and practices, some issues become apparent such as the need for flexibility in funding. Funding can be made available in specified or unspecified blocks and is sometimes marked as a technical resource. Dynamic fund management is necessary to respond to evolving needs and changing priorities. It is necessary to avoid over-funding some areas while leaving other areas under-funded.


Page 47

In understanding the preferred channels and mechanisms of funding it is necessary to recognize the limitations of the Flash Appeal and CAP. Factoring health in bilateral funding channels must be improved as well as learning from experiences with multi-donor trust funds. Lowering of transaction costs has been highlighted as a major issue and can be addressed through consolidated proposals, unified reporting, alignment and harmonization of aid.

Summary of past progress in working toward alignment and harmonization

The UN Summit in 2005 asked partners to take a close look at the need for alignment and harmonization and it was acknowledged that there is a need for centralized revolving funds. The Paris Declaration was consequently developed that endorsed the following Five Principles:

(1) Ownership – Countries are the primary owners

(2) Alignment – Agendas should be aligned with that of the recipient country

(3) Harmonization – Reduce multiple formats and the administrative burden to the recipient country

(4) Managing for Results – Not just proposals, but concrete results

(5) Mutual Accountability – All partners benefit from an accountable system

Greater inter-agency cooperation can be achieved through reform, the new cluster approach and an improved partnership framework. The Cluster approach developed by

Inter Agency Standing Committee for Humanitarian Action identified nine clusters, one of which is the Health Cluster that is led by WHO. Additional resources may be necessary to make the cluster approach fully operational.

In-kind donations are an aspect of funding that result in a volume of medical supplies and relief equipment. A systematic approach to transportation, storage, installation, maintenance and insurance is necessary


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to support the movement and distribution of such donations. Scientific disposal and management of waste is sometimes necessary as a result. In-kind donations can flow through the bilateral route, but it is important for governments to be able to say “No” if the donation does not meet the need.

The issue of capacity building is another crucial component of the funding landscape. Among those in need of capacity are national authorities, local communities and recipient agencies. Capacity building is often needed in planning and preparedness, gap-filling and building community resilience. Needed support can come from donors (from core funds) and should also be supported by the WHO – extrabudgetary resources. Building capacity should also include resource mobilization and more effective and efficient management of aid. Money can have an inverse effect on capacity building if time is a constraint. With little time and more money (push effect), organic developments within institutions are hampered.

Sustainability is always a concern and funding patterns should not exacerbate existing inequalities nor distort resources from existing priorities. The phase of rehabilitation and reconstruction should have a special emphasis in terms of planning for sustainability in addition to the emergency phase and the maintenance of start-ups.

Actions that can come from the lessons learnt from the tsunami response include:

Ø Continued advocacy with and feedback to donors

Ø In-Region resource mobilization – Member states as donors

Ø Examples of Central Emergency Response Fund and National Disaster relief funds

Ø Creating a regional buffer – contingency fund

A key point also taken from the tsunami operations is that support during times of crisis needs to be maintained during non-emergency times with the aim of strengthening emergency preparedness and response and should be considered as an investment.


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Ø Challenges faced by large organizations: Many large NGOs face the same challenges as WHO in addressing funding issues. Some organizations, such as inter-regional banks, are not currently organized to effectively respond to emergencies and may be currently stronger in response to the needs of rehabilitation and recovery phases. Regional disaster planning should, however, include all partners. In Latin America, there is a history of strong partnership with regional banks in designing development programmes that are cognizant of the threat of disasters and incorporate appropriate precautions in planning.

Ø Influence of the media on funding: As natural disasters are increasing worldwide, media coverage has increased in parallel. The “CNN effect” has a large impact on the amount of attention given to a disaster and, as such, can complicate funding once the public eye moves on. In the case of Yogyakarta and Central Java, earthquake needs were clearly expressed and aid organizations and agencies responded, but the role of the Health Cluster in this success was not clear. WHO seems to have a strong relationship with the Ministry of Health, but weaker relationships with NGOs. The Health Cluster seems to be further strengthening the WHO-MoH relationship but further weakening the relationship with NGOs. NGOs have a clear presence in some Clusters, but not in the Health Cluster (in the case of Yogyakarta) which suggests WHO could work harder to improve its leadership role and improve NGO involvement.

Ø Areas of focus: Funding for the health sector was an important component of the Flash Appeal for Yogykarta. WHO should not attempt to work in areas that are not its strength, such as building hospitals, but should instead focus on coordinating with and supporting those who can. Proposals for funding should additionally be appealing for those not in public health. The Multi-Donor Trust Fund is administered by the World Bank and co-chaired by the BRR and the European Commission. The Fund has focused on using the pooled funds to address gaps, a model that WHO could perhaps learn from. The impression is that the health sector is over funded in Aceh and the challenge is to rebuild health systems using the strengths of the Organization and using others when weaknesses within the Organization are identified. Competencies must be validated and employed more productively.


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Ø Competition for funding: The relationship between WHO, MoH and NGOs is complex in light of the proliferation of NGOs. Relief work is fast becoming an industry as the competition is not always healthy but a drain on limited resources. We must ask where is the value added and who is bringing it. Many material commodities have posed a burden on local capacities and have not met identified needs.

Ø Regional Contingency Fund: Support for the Regional Contingency Fund was expressed as an estimate of needs that can be established as evidence exist for the needs of each specific type of disaster. The funding available does not always fill the need.

Ø Heterogenous role of NGOs: NGOs can not be referred to as if they are a homogenous group as some fill very specific niches that would otherwise be left unattended. The Health Cluster is often lead by WHO and the MoH. WHO should be able to tap the dynamism. WHO is additionally not meeting the needs of the recovery period in Aceh as some feel the reduced staff has left the health sector and government lacks the needed support. The post-tsunami experience in Sri Lanka highlighted the specific capacities of WHO as NGOs were valuable in providing immediate medical care and WHO rationalized public health issues. WHO should be a facilitator, not a provider.

Ø Impact on local providers: In response to the influx of foreign doctors in Aceh, many local doctors left public hospitals to work in the community as private doctors so that they could increase their income. The impact of relief efforts has on local providers should be carefully considered to avoid unintended consequences.

Ø Health Cluster: The use of the Health Cluster in Aceh was the first time this new method of coordination was employed. There were over 40 organizations working in Yogyakarta, which was a much more manageable size than the over 300 that were active in the health sector in Aceh. WHO is still learning the best methods for engaging with NGOs while trying to promote and support the leadership of the government. Inappropriate responses must be weeded out so that development priorities are in line with government agendas.


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Consultation Conclusion

The concluding session of the meeting was chaired by Dr. Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region. Dr Singh summarized the key issues brought up in the meeting, and elucidated on how the suggestions and ideas from the meeting could be translated into action for a better prepared Region.

Some fundamental issues included the need for improved evaluation, and needs assessment. Evaluation procedures need to look at what is being evaluated, and for whom, and what it is based on. Similarly, a baseline is needed for effective needs assessments. The extent of damage, the available resources, and the cultural settings, need to be taken into account. Accordingly, priorities should be set in the response. Advocacy and health risk communication were also important aspects to be kept in mind.

All these issues highlight the need for standards. In this context, the Bangkok benchmarks are considered realistic and achievable, and applicable in all emergencies, and not limited to sudden-onset natural hazards. These are a good starting point for countries of the Region although they may need to be further refined.

Based on all the issues discussed at the consultation, the ‘Bali Declaration: A Commitment to Action’ was drafted. This was further discussed and refined by the participants in the concluding session. The Declaration emphasized that multi-hazard disaster preparedness was crucial to prevent future emergencies from spiralling into disasters. This needs appropriate disaster management structures in governments, adequate and properly trained human resources, as well as financial resources. Stronger and more flexible health systems are needed, which will improve the benefits to the community in ordinary circumstances as well as meet the challenges posed during emergencies. Greater advocacy, planning and coordination will ensure that recovery, reconstruction and rehabilitation contribute to the long-term functioning of health systems.

While the Bangkok Meeting Benchmarks are a good starting point, in order to ensure multi-hazard disaster preparedness in the Region, they need to be converted into strategic action points with quantifiable indicators and specific timelines.


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In order to meet the gaps in financial resources for disasters, the creation of a Regional Solidarity Fund for Emergency Response has been suggested.

Many of the issues raised at the consultation have been brought up due to lessons learnt from recent emergencies. It is important to capture and document those lessons, and monitor the progress in reducing vulnerability to disasters in the Region.


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Annex 1

Bali declaration: A commitment to action, (29 June 2006)

The participants at the Regional Meeting on Emergency Preparedness and Response: From Lessons to Action, held in Bali, Indonesia from 27-29 June 2006,

Recognizing that:

Ø The devastating Tsunami of 26 December 2004 yielded profound lessons and, as we move forward, it has opened windows of opportunity to improve the health management of and response to future disasters;

Ø Despite efforts to improve disaster preparedness and reduce the impact of disasters on the health and well-being of their populations, the frequency and magnitude of impact of natural disasters continue to grow and will have a negative impact on health, health infrastructure, and social and economic development;

Ø Affected communities themselves are the first to respond to disasters and that the effectiveness of their response is directly linked to community solidarity and a commitment to invest in emergency preparedness;

Ø An effective health response to emergency situations demands continuous coordination with multiple actors across sectors before, during and after disasters; and

Ø The benchmarks established at the November 2005 Meeting on the Health Aspects of Emergency Preparedness and Response (Bangkok, Thailand) provides a guide for sustained regional and national action.

Resolve to:

Ø Urge Member States in the Region to improve multi-hazard disaster preparedness, with particular emphasis on creating an appropriate disaster management structure in governments, with adequate human and financial resources and access to decision-making levels;

Ø Reinforce efforts to empower communities to take a pivotal role in the multi-sectoral response to disasters by identifying and fulfilling resource gaps including training and building on already existing capacities;


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Ø Develop new and/or improve existing coordination mechanisms among sectors, governments, NGOs and other agencies within and across countries to improve the flow of information in all directions and facilitate the optimal use of resources;

Ø Advocate and plan for responses that ensure that recovery, reconstruction and rehabilitation contribute to long-term functioning of health systems;

Ø Convert the Bangkok Meeting Benchmarks into a strategic action framework by developing measurable indicators with timelines;

Ø Promote the creation of a Regional Solidarity Fund for Emergency Response, a regional team approach and other mechanisms; and

Ø Capitalize on the lessons learned from recent emergencies by systematically capturing, documenting and exchanging examples of progress achieved and translating these into best practices for reducing disaster vulnerability in Member States of WHO’s South-East Asia Region in a sustainable and cost-effective manner.


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Annex 2

Welcome speech by Governor of Bali

The honourable Minister of Health, Republic of Indonesia, Regional Director of the World Health Organization, All delegates from the United Nations and 11 Members countries of WHO South-East Asia Region, All Participants, Ladies and Gentlemen,

Om Swastyastu,

First of all, I am grateful to the almighty God, Ida Sanghyang Widhi, that through His blessings we can gather here with happiness and wellness to attend this opening ceremony of the Regional Consultation on Emergency Preparedness and Response: From Lessons to Action, here in Bali.

Welcome to Bali to all participants, especially those who come from outside Bali and from abroad. We hope besides attending this conference you may also enjoy the beautiful scenery of this island.

Distinguished guests, Ladies and Gentlemen:

It is clear in our mind that many disasters are occurring in many places, not only natural disasters but also man-made disasters, beside daily emergencies that have been increasing in quantity and severity. We confess that emergency responses have already been actuated, but we still sporadic and unstructured since Emergency Health Services and Disaster has not been the main agenda of our Health Development. But we believe that disaster and emergency health services is still our concern because health is a human right and it is our task to create together with all components including the community, on a “Comprehensive Emergency Disaster Management System”.

Ladies and Gentlemen,

Bali is one of the main tourist destinations of the world, geographically and politically it is in high risk of disaster, natural or man made. We have experienced several kinds of disasters like earthquake, tsunami, volcano explosion, landslides, flood, political chaos, and the last disaster were bombing attacks in 2002 and 2005 which caused hundreds of deaths.


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Although we offer our deep condolence to all the victims, we are proud of all our health brigade who used their skills to help and rescue victims, in coordination with other helpers and the community.

If we compare what happened in the first bomb explosion in 2002 and the last one in 2005, we will get several experiences and lessons learned since, during the first bomb explosion, all the systems, management and functional system collapsed. Emergency services were provided without a respective system, hospital communication was interrupted, pre-hospital communication was damaged, there was even no field triage. All victims were transferred to hospital and the nearest clinic without basic life services, just “load and go”. Fortunately, with the hard work of all health workers, volunteers, and medical helpers also coming from abroad, the fatalities could be minimized.

“Experience is the best teacher”. The bad experienced in the past might be a lesson to establish a better system in emergency and disaster preparedness. In the second, and hopeful the last bomb explosion in 2005, the new system has already been run, and needs to be followed by several drills and simulations and medical trainings in order to be ready in the future.

Ladies and Gentlemen,

Through this opportunity I invite all of you to review what we have done in emergency and disaster services in Bali Bomb I and II as lessons learned. I hope we will get some good suggestions to establish the best system in Emergency and Disaster.

I appreciate that you have selected Bali to hold this regional consultation on emergency and disaster. I hope through this meeting we will get some benefits, especially to be more responsive in the future.

Finally, I wish you have a good discussion and field trip. I suggest you all visit some beautiful scenery and experience Balinese culture during stay in Bali.

Thank you very much.

Om Shanti, Shanti, Shanti, Om.


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Annex 3

Keynote address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia

Distinguished participants, Representatives of partner organizations, Guests, Colleagues, Ladies and gentlemen,

It is with great pleasure that I warmly welcome you all to this Regional Consultation. It is an opportunity for all of us to learn from the past, in order to be able to cope better in the future. This is particularly so in countries of the South-East Asia Region, where risks and hazards of various types are prevailing. We have seen time and again that communities and nations have been able to cope with these events. Just a month ago, Indonesia witnessed a devastating earthquake in Yogyakarta. More than 6000 people died, over 20000 were injured, and 100000 to 600000 were displaced. In this event, two things stood out clearly. The first was that preparedness is vital. Joint preparations by the government and all concerned sectors with regard to the eruption of Mount Merapi helped to put in place important resources that were easily mobilized for the earthquake. Secondly, the lessons from the tsunami were demonstrated. A strong response by the government provided the desired direction to all humanitarian actors.

It is also worth mentioning that the operational guidelines developed during the tsunami helped in the emergency in Yogyakarta as well. A well-developed health system provides a strong base for an emergency response. The provincial health system of Yogyakarta is well resourced with health facilities and health professionals. The system that is in place can cope with the surge of patients. Assistance was mobilized from neighbouring provinces, and international support helped to augment what was already on the ground. We, in WHO, also learnt important lessons. We were able to better support the Ministry of Health in this emergency. We were able to coordinate better within the Organization and with partners. Our effectiveness and efficiency was demonstrated through prompt provision of necessary supplies and staff. It is heartening to note that we were able to respond quickly and effectively.

Yet, there still are many emergencies that we have to face. We had a crisis in Nepal this year; the Timor-Leste civil conflict; and the floods in Northern Thailand. We can share the lessons learnt and apply them in the different contexts and


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circumstances. It is, therefore, important to revisit and discuss our experiences, with the view to derive the maximum gains from such lessons.

At this point, distinguished participants, I would like to refer to the tsunami. It is exactly one and a half years since it struck six countries in the South-East Asia Region. It was one of the worst natural disasters in recent history. It caused unprecedented destruction; killing hundreds of thousands of people, and affecting a population of more than two million. The challenges were really enormous. There was no time to lose. We had to respond quickly and effectively, especially in the emergency phase. At the same time, we had to work in a coordinated manner with all stakeholders.

In such a difficult situation, WHO spared no efforts in supporting the affected countries. The very first attempt was to save lives and mitigate the suffering of the people. Because of the magnitude of the devastation, the tsunami emergency and recovery phase lasted for very long, that is for one and a half years. Now, it is time to focus more sharply on rehabilitation and reconstruction.

Before we move on, we must reflect on what we have done well, and where we could have done better. This is with the view to make the best use of these lessons for the future. At this consultation, we will review what has been done for the tsunami, and learn new lessons. We will also recapitulate the major directions and activities for rehabilitation and reconstruction. In the process, we can identify gaps and actions needed for countries in the Region to enhance country capacity for emergency preparedness and response in the Region.

We have made good progress following the tsunami. We, together with countries:

(1) Have set up disease surveillance systems;

(2) Developed community mental health programmes;

(3) Strengthened emergency preparedness and response, and

(4) Improved the systems for management of wastes and water resources.

These are just a few examples. Psychosocial needs of the tsunami-affected people contributed to the changes in mental health legislation in Sri Lanka. Changes in the supply management system in Maldives were brought forth, mainly as a result of the response to the tsunami. In India, the government has improved its emergency coordination through a National Disaster Management Authority.


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We cannot, however, become complacent as the tsunami revealed many gaps in our response. These were in the areas of policy, legislation, planning, human resources, operation and coordination. In many countries, there was no disaster management system in place, so response was delayed due to confusion about what needed to be done, and by whom. In some places, financial resources did not come through quickly, and therefore the response was held up. People with different skills and expertise were needed, but mobilizing them took time because there was no resource database.

In many places, facilities collapsed because they were built without disaster resistance in mind. Coordination among communities, districts, national governments, international agencies and nongovernmental organizations was not smooth. The global response was tremendous, but to be effective, it needed to be efficiently coordinated. The tsunami has demonstrated that the better prepared a country is, the more effective it can be in responding to any disasters.

We know that emergency preparedness is a part and parcel of national development. It is essential for governments to include it in their national development strategies and plans. This year, the World Health Assembly, once again, underlined the need to strengthen the capacity of Member States in emergency preparedness and response. Last year, the WHO Regional Committee for South -East Asia also provided direction on several key issues so that Member States can move forward rapidly in strengthening their national capacities for emergencies. WHO has assisted countries in strengthening their capacities in the health sector. To this end, in November last year, we invited representatives from all our Member States in the Region to a meeting to discuss various related issues. This meeting then identified a number of key benchmarks that every country should aim to fulfill in mitigating disasters. These benchmarks include, among others:

(1) A legal framework and functioning coordination mechanism;

(2) Disaster preparedness plans and standard operating procedures (SOPs);

(3) Community-based response and preparedness capacity;

(4) Risk identification and vulnerability assessment, and

(5) Trained human resources; disaster-resistant health facilities and early warning systems.

Last month, when the earthquake struck Yogyakarta, we saw how important it was to meet these benchmarks. Indeed, the theme of this meeting is also to put


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together what we have learnt and how we can apply them in emergencies. Let us take them forward in the next three days as there is no end to learning. We need to keep ourselves constantly updated on all aspects of management of an emergency. Let us keep the momentum moving towards better systems for emergency preparedness and response. This is with the view to ensuring that we will be able to cope with any emergencies in the most efficient and effective manner. Only then can we say that our efforts have not been in vain. In conclusion, I wish you the most productive deliberations; and a pleasant stay in Bali.

Thank you.


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Annex 4

Inaugural address by Minister of Health of the Republic of Indonesia*

First of all, I would like to extend my gratitude and heartfelt thanks for your visit to Bali, you are very much welcome.

It is a great honour indeed that WHO is holding the Regional Consultation on Emergency Preparedness and Response: From Lessons to Action in Bali, Indonesia.

As we are aware, this is an important and strategic meeting since it discusses recent disasters and crisis, especially in Indonesia, and it is attended by users, providers, UN agencies, NGOs and donors. I believe this meeting will be very useful and effective, not only for Indonesia but also for other countries.

Distinguished Guests, Ladies and Gentlemen,

Indonesia is a disaster-prone country due to its geological and geographical conditions. For many centuries, natural disasters such as earthquakes, volcano eruptions, floods, landslides, as well as drought and consequent famine have presented a serious and even increasing threat to many parts of the country.

Large-scale epidemics of emerging and newly emerging diseases such as avian influenza that caused a lot of deaths in Indonesia, terrorism, armed conflict, turmoil, and technological disasters may also become potential threats to the country, which could affect large populations.

Disaster management in Indonesia is a significant problem. While tsunami relief in Nanggroe Aceh Darussalam has not finished yet, a new disaster emerges. A month ago, an earthquake hit Yogyakarta and Central Java causing 137,000 injured and 5,400 people had to undergo operations; and destroyed 120,000 houses and more than 200 health facilities. Not long after that, South Sulawesi got flash floods which killed more than 200 people.

* Delivered by Dr Nyoman Kandun, Director General, Communicable Disease Control and Environmental Health, Ministry of Health, Government of Indonesia


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A lot of efforts have been made in order to reduce the loss by strengthening the coordination, solidarity and quick response from the national and international community and organizations so that we can prevent the bigger loss from disasters and crisis response can be implemented effectively.

We would like to thank to World Health Organization and other international organizations for their support to Indonesia and other countries both in mobilizing health resources, providing supplies and coordinating the international agencies before, during and after disasters. The partnership and solid cooperation between international organizations and the Ministry of Health, Republic of Indonesia has created a system to overcome health crisis and problems in Indonesia. The support and assistance is very much appreciated.

Distinguished Guests, Ladies and Gentlemen,

I would like to take this opportunity to invite you to visit Sanglah Hospital, as one of the Ministry of Health hospitals which has the best standard in disaster emergency response and preparedness among others in Indonesia. It was proven when Bali Bomb Blast II occurred, the response time to manage it was less than 20 minutes. However, we realize that it has not met the international standard yet. Therefore, your support and advice is very much needed.

Finally, on behalf of the Government of Indonesia, and the Ministry of Health, I would like to convey our appreciation to WHO and international communities for their efforts, especially in preparedness to reduce the disaster risks.

I thank you for your attention.


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Annex 5

List of participants

Bangladesh

Mr Muhammad Aminul Islam Bhuiyan Additional Secretary Ministry of Health and Family Welfare Bangladesh Secretariat, Dhaka

Mr Rafiqul Mahamed Director-General Disaster Management Bureau Ministry of Disaster management & Relief Government of Bangladesh Dhaka

Bhutan

Dr Sonam Ugen Joint Director Department of Public Health Ministry of Health, Thimphu

Dr Gosar Pemba Technical Focal Person for Emergency Preparedness Jigme Dorji Wangchuk National Referral Hospital Thimphu

Ms Sonam Deki Communication Officer Disaster Management Division Department of Local Governance Ministry of Home and Cultural Affairs Thimphu

India

Dr Ravindran Director, Emergency Medical Relief Ministry of Health and Family Welfare Government of India Nirman Bhawan New Delhi 110011

Mr Rajiv Kumar Director National Disaster Management Division Ministry of Home Affairs Government of India North Block, New Delhi 110 001

Indonesia

Dr Rustam S. Pakaya, MPH Head of Crisis Centre Ministry of Health, Jakarta

Dr Mahmud Ghaznawie, PhD University of Hasanuddin Makassar

Ir Syaifudin Husein Secretary to the Crisis Centre Provincial Health Office Nanggroe Aceh Darussalam (NAD)

Dr Dewa Ketut Oka Chief Provincial Health Office

Dr I Wayan Sutarge Sanglah Hospital Bali

Mr I Putu Pudja BMG Jakarta

AKBP, Dr Antonius R. Castilani Pusdokkes POLRI Jakarta

Maldives

Mr Abdul Samad Abdul Rahman Deputy Director Department of Medical Services MoH, Male


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Captain Wais Waheed Ministry of Defense and National Security Male

Ms Thasleema Male

Sri Lanka

Mr J K R A Perera District Disaster Management Coordinator Ampara

Dr H.S.B. Herath Medical Officer Ministry of Healthcare & Nutrition Colombo

Thailand

Dr Pornpet Panjapiyakul Chief of Academic Service Section Bureau of Health System Development Department of Health Service Support Ministry of Public Health

Mr Wichit Chuncuansungkom Civil Engineer Disaster Prevention Measures Bureau Department of Disaster Prevention and Mitigation Ministry of Interior

WHO EHA Focal Points from Countries

Dr Kazi A.H.M. Akram, NPO (CD) Bangladesh

Mr A.K. Sengupta, NPO (SDE) India

Dr Vijay Nath Kyaw Win Indonesia

Dr Gita H. Tarigan Indonesia

Dr Sulasmi Yeddi NAD, Indonesia

Ms Laila Ali Maldives

Mr P.P. Singh Myanmar

Dr Maung Maung Lin NPO, Myanmar

Mr Erik Kjaergaard Nepal

Dr B.K. Verma Sri Lanka

Dr Hendrikus Raaijmaker Sri Lanka

Mr Han Antonius Heijnen Sanitary Engineer Nepal

Mr Chawalit Tantinimitkul, STP-Technical Officer on CDS/EHA Thailand

Dr Teodulo C. Jesús Ximenes Timor-Leste

Temporary Advisers

Mr Jonathan Abrahams Team Leader, Public Health in Emergencies Asian Disaster Preparedness Center (ADPC) Thailand

Lt. Gen. Amnat Barlee Director Relief and Community Health Bureau The Thai Red Cross Society 1871 Henry Dunant Road Patumwan Bangkok 10330 Thailand

Mr Marvin Birnbaum President World Association of Disaster and Emergency Medicine

Dr Manuel Carballo Executive Director ICMH Geneva


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UN Agencies

Ms Rosilawati Anggraini UNFPA

Mr Ali Mansoor UNICEF

Ms Reiko Niimi UN OCHA

Donors Partners

Mr James Sonnemann ADB

Mr John Kolff MERLIN International

Dr Yolanda Bayago MERLIN International

Mr Peter Cameron IFRC

WHO Secretariat

Dr Poonam Khetrapal Singh Deputy Regional Director WHO/SEARO

Dr Luis Jorge Perez Regional Adviser Emergency Preparedness and Response WHO/SEARO

Dr Roderico Ofrin Technical Officer Emergency Preparedness and Response WHO/SEARO

Ms Patricia Bittner Program Management Officer, EPR, WHO/AMRO/PAHO

Dr Subhash R. Salunke Communicable Diseases Surveillance and Response WHO/SEARO

Dr Vijay Chandra Regional Advisor Mental Health & Substance Abuse WHO/SEARO

Dr Yonas Tegegn Strategic Alliance and partnerships WHO/SEARO

Mrs Harsaran Bir Kaur Pandey Public Information and Advocacy Officer WHO/SEARO

Dr Qudsia Huda STP-Tsunami Operations Manager WHO/SEARO

Mr Arindom Mookerjee STP-Emergency Preparedness and Response WHO/SEARO

Dr Supriya Bezbaruah STP-Emergency Preparedness and Response WHO/SEARO

Administrative Supports

Mr J.K. Verma Administrative Assistant Office of Deputy Regional Director WHO/SEARO

Mr S. Sornakaleeswaran Secretary Emergency Preparedness and Response Unit WHO/SEARO

Mrs Kamilani Baniwati Usodo Assistant I (Meetings and Library) WHO Indonesia Jakarta

Mr Firdaus Fanani Registry WHO Indonesia Jakarta


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Annex 6

Programme

Tuesday, 27 June 2006

08:00-09:00 Registration

Opening Session Ø Welcome Address Dr Dewa Ketut Oka

Head, Bali Provincial Health Office Ø Keynote Address Dr Samlee Plianbangchang,

Regional Director, WHO/SEARO Ø Inaugural Address Dr Nyoman Kandun, Director General,

Communicable Disease Control and Environmental Health, Ministry of Health, Government of Indonesia

09:00-10:00

Ø Group Photograph

10:00-10:15 Tea/coffee

10:15-10:30 Objectives of the Meeting Dr. Luis Jorge Perez, Emergency and Humanitarian Action, WHO/SEARO

10:30-11:00 Health in Emergencies: Global Perspectives

Discussion

Dr. Ala Din Alwan, Representative of the Director General, Health Action in Crises, WHO/HQ

11:00-11:30 Review of the Tsunami Response

Ø What has been learnt?

Ø What have we done about it?

Ø Current gaps?

Dr Luis Jorge Perez, Emergency and Humanitarian Action, WHO SEARO


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11:30-12:30 Lessons Learnt: Sharing Experiences on Community Empowerment

Discussion

Lt. Gen. Amnat Barlee, Director, Relief and Community Health Bureau, Thai Red Cross Society

Discussant: Dr Vijay Chandra, Regional Advisor, Mental Health, WHO SEARO

12:30-14:00 Lunch

14:00-15:15 Lessons Learnt: Sharing Experiences on Multi-sectoral Coordination

Discussion

Mr Rajiv Kumar, Ministry of Home Affairs, Government of India

Discussant: Dr. Bipin Verma, EHA Focal Point, Sri Lanka

15:15-15:45 Tea/Coffee

Lessons Learnt: Sharing Experiences on Strengthening Country Capacity for Preparedness and Response

Discussion

Mr. Jonathan Abrahams ADPC, Bangkok

Discussant: Dr Roderico Ofrin Technical Officer, EHA, WHO SEARO

15:45-17:00

Session Chair: Dr Poonam Khetrapal Singh

Deputy Regional Director, WHO SEARO

Wednesday, 28 June 2006

09:00-09:10 Recap of Day 1 Dr Marvin Birnbaum President, World Association of Disaster and Emergency Medicine

09:10–10:40 Issues from Evaluations of Tsunami Operations

Discussion

Dr. Manuel Carballo, Executive Director, International Centre for Migration & Health, Geneva

Discussant: Dr Qudsia Huda, STP- Tsunami Operations Manager


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10:40–11:00 Tea/Coffee

Applications of Lessons Learnt from Tsunami

Ø Review of Health Sector Response for the Yogyakarta Earthquake

Dr Rustam S. Pakaya, Ministry of Health Indonesia, Crisis Centre Coordinator

11:00–11:30

Ø Issues Related to Pandemic Preparedness

Dr Subhash R. Salunke Communicable Diseases Surveillance and Response WHO/SEARO

11:30–13:15 Group Work – Session I

Processes and Desired Outcomes of Group Work

Dr Roderico Ofrin, Technical Officer (EHA), WHO SEARO

Group 1: Benchmarks on Multisectoral Coordination Facilitator: Dr Vijay Chandra, Mental Health and Substance Abuse, WHO SEARO

Group 2: Benchmarks on Community Empowerment Facilitator: Mr Han Heijnen, Sanitary Engineer, WHO Nepal

Group 3: Benchmarks on Capacity Building Facilitator: Dr Qudsia Huda, STP – Tsunami Operations Manager

Group 4: Benchmarks on Standards and Guidelines Facilitator: Dr Yonas Tegegn, Strategic Alliance and Partnerships, WHO SEARO

13:15–14:15 Lunch

14:15–16:00 Group Work – continued (groups and meeting venue remain the same)

16:00–17:00 Plenary Session: Presentations by Work Groups

Discussion

Dr Marvin Birnbaum, President, World Association of Disaster and Emergency Medicine


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Thursday, 29 June 2006

09:00-09:10 Recap of Day 2 Dr Marvin Birnbaum President, World Association of Disaster and Emergency Medicine

09:10-10:30 Roundtable with Partners: From Lessons to Action

Detailed agenda to be provided

Speakers: Representatives from donor agencies and NGOs

Discussants: Dr Yonas Tegegn, Strategic Alliance and Partnerships, WHO SEARO; Mr Arindom Mookerjee, EHA/WHO SEARO

10:30-11:00 Tea/Coffee

11:00-12:00 Closing Session

Ø Review and Adoption of the Bali Declaration

Ø Closing Remarks

Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO SEARO

Session Chair: Dr Poonam Khetrapal Singh

Deputy Regional Director, WHO SEARO

12:00-13:30 Lunch

13:30 onwards Field visit – Mass Casualty Management in Bali / Pandemic Preparedness in Bali


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Annex 7

Benchmarks

(1) Legal framework and functioning coordination mechanisms and an organizational structure in place for health EPR at all levels involving all stakeholders;

(2) Regularly updated disaster preparedness and emergency management plan for health sector and SOPs (emergency directory, national coordination focal point) in place;

(3) Emergency financial (including national budget), physical and regular human resource allocation and accountability procedures established;

(4) Rules of engagement (including conduct) for external humanitarian agencies based on needs established;

(5) Community plan for mitigation, preparedness and response developed, based on risk identification and participatory vulnerability assessment and backed by a higher level of capacity;

(6) Community-based response and preparedness capacity developed, supported with training and regular simulation/ mock drills;

(7) Local capacity for emergency provision of essential services and supplies (shelters, safe drinking water, food, communication) developed;

(8) Advocacy and awareness developed through education, information management and communication (pre-, during and post-event);

(9) Capacity to identify risks and assess vulnerability at all levels established;

(10) Human resource capabilities continuously updated and maintained;

(11) Health facilities built/modified to withstand expected risks, and

(12) Early warning and surveillance systems for identifying health concerns established.

emergency preparedness and response: from lessons to action · emergency preparedness and response:...

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